Customised professional learning and consultancy with ECA: Expression of Interest

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* 1. Name of contact person at service or organisation

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* 2. Phone number

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* 3. Email

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* 4. Service or organisation name

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* 5. Address

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* 6. Setting type (eg. Long day care, family day care)

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* 7. Exact number of participants

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* 8. How many room/teams would be participating in the training?

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* 9. Are there educators from different services/across an organisation/FDC scheme or OSHC programs coming together to complete the training? (Please give details)

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* 10. Are you currently an ECA Learning Hub subscriber?

Yes

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* 11. Are you currently an ECA member? If so what type of membership?

Not a member

Service/School Membership

Professional Membership

Student/Concession Membership

Institution Membership

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* 12. Please enter your ECA Membership number if applicable.

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* 13. Approach to customised training required (you can select more than one)

Face-to-face workshop

Virtual workshop

Keynote presentation

Action research project support

Research and evaluation

Online professional learning (e.g. module, webinar etc.)

Mentoring or coaching

Written publications (e.g. books, articles etc.)

Consultancy

Strategic planning

Facilitated learning circle

I'm unsure what I need

Other (please specify)

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* 14. Is there a particular trainer you would like to deliver this training? (Enter their name here)

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* 15. Do you have a pre-approved or set budget for this customised training?

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* 16. Please describe the area of need/topic area - Why is this training needed?

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* 17. Do you have a preference for day/evening training sessions? Please provide a minimum of three dates. Please note, we require one months notice beforehand.

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* 18. Do you have any additional comments to help us customise your training?

Following receipt of this form you will receive a follow up conversation with one of ECA’s professional learning team to discuss your professional learning and consultancy needs.