MyRoad School Interest Form

BOOKING FORM

To request a MyRoad session for your school, please complete the form below. Bookings are not final until confirmed by the MyRoad team. Use ‘tab’ to move between fields in this form.

MyRoad School Booking Request

Name of School *

School website address

Paste home page URL

Name of your representative at Beacon

School address *

Street

School Address *

Suburb

School address *

State

Educator's Details *

First name

Last Name *

Last name

Best days/time to contact

Email *

Email (a copy of this form will be sent to this address)

Phone - School/Business Hours *

Area Code

Phone - School Hours (NUMBER/EXTENSION) *

Number (and extension, if applicable)

Mobile *

Mobile

Proposed total number of students to attend the MyRoad session *

Note: bookings are open only for female students aged 16 to 19 or turning 16 that year.

Proposed ratio of students to mentor in each group - based on room size, computer logistics, noise, etc. *

Select a group size of 3 or 4 students to each mentor.

Year level/s of participating students *

Year 10

Year 11

Year 12

Preferred Date *

Start Time *

Session duration is strictly 2 hours

Time Zone *

(ie AEST/ADST/ACST/AWST)

Comments/Questions

Provide any additional information, such as class demographics, which may be useful to our mentors, or ask a question.

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MyRoad School Interest Form

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