Student Placement Request
Student Name
*
First Name
Last Name
Email Address
*
example@example.com
Contact Number
*
Please enter a valid phone number.
Format: 0000 000 000.
Name of school/university/TAFE/organisation
*
Course Name
*
e.g., Certificate III, Diploma, Degree, Work Experience, etc.
Days Requesting
*
Monday
Tuesday
Wednesday
Thursday
Friday
Dates Requesting
*
Start Date and End Date
Total Days Requesting
*
e.g., 20
Age group/s Requesting (select all if N/A)
*
0 - 2 (Murrum Room)
2 - 3 (Guyip Guyip Room)
3 - 4 (Barrawang Room / 3-y-o Kindergarten Room)
4 - 5 (Balam Balam Room / 4-y-o Kindergarten Room)
Anything else we need to know?
e.g., accessibility, family committments, etc.
Submit
Should be Empty: