2012 South Australian Expressions of Interest

Get into Genes - 2012 South Australian Expressions of Interest

Please complete the following Expressions of Interest form for Get into Genes, 2012.

If you have any further requests/enquiries, then please don't hesitate to contact Alison Wilson - alison.wilson@acpfg.com.au

*
1. Teacher contact details:

Teacher contact details: Name:
School:
Address1:
Address2:
City/Town:
Postcode:
email address:
Phone Number:

2. Type of School

Type of School Government

Non-Government / Independent

Post-Secondary School (eg first year University students who have not previously done Biology

3. Year level

Year level Year 9/10 science

Year 11 Biology (SACE and IB)

Year 12 Biology (SACE and IB)

Year 11 Chemistry (SACE and IB) Chemistry focus

Other (please specify)

4. Preferred Location

Preferred Location Waite Campus, The University of Adelaide, Urrbrae

Outreach / Rural school

5. Preferred booking time:
(feel free to tick more than one week. Someone will contact you next year to confirm a specific date)

	week 1	week 2	week 3	week 4	week 5	week 6	week 7	week 8	week 9	week 10
Term 1	*Preferred booking time: (feel free to tick more than one week. Someone will contact you next year to confirm a specific date) Term 1 week 1	Term 1 week 2	Term 1 week 3	Term 1 week 4	Term 1 week 5	Term 1 week 6	Term 1 week 7	Term 1 week 8	Term 1 week 9	Term 1 week 10
Term 2	Term 2 week 1	Term 2 week 2	Term 2 week 3	Term 2 week 4	Term 2 week 5	Term 2 week 6	Term 2 week 7	Term 2 week 8	Term 2 week 9	Term 2 week 10
Term 3	Term 3 week 1	Term 3 week 2	Term 3 week 3	Term 3 week 4	Term 3 week 5	Term 3 week 6	Term 3 week 7	Term 3 week 8	Term 3 week 9	Term 3 week 10
Term 4	Term 4 week 1	Term 4 week 2	Term 4 week 3	Term 4 week 4	Term 4 week 5	Term 4 week 6	Term 4 week 7	Term 4 week 8	Term 4 week 9	Term 4 week 10

6. Request a specific date for 2012 / any other comments

Request a specific date for 2012 / any other comments

7. Where did you hear about 'Get into Genes' ?

Where did you hear about 'Get into Genes' ? 'Get into Genes' website

SASTA advertisement

Science Pages website

Email from Get into Genes

Word of mouth

Trade Display at schools

Other