FACULTY OF EDUCATION AND SOCIAL WORK
INTERNATIONAL PROFESSIONAL LEARNING PROGRAM REQUEST
Please complete this form electronically by typing in the boxes provided. The boxes will expand as needed. Save the
form as a Microsoft Work .doc file, and send back to us as an email attachment to: lesley.harbon@sydney.edu.au
FULL NAME OF ORGANISATION
MAKING REQUEST
CONTACT PERSON
CONTACT EMAIL ADDRESS
COUNTRY OF ORIGIN OF
PARTICIPANT GROUP
PROPOSED DATES FOR
PROGRAM
SIZE OF GROUP WHO REQUIRE
THIS PROGRAM
GENDER COMPOSITION
(eg 10 men 20 women)
BACKGROUND INFORMATION
AND CONTEXT FOR THIS
INTENDED PROGRAM
(eg experienced school principals;
beginning teachers of English)
ACADEMIC QUALIFICATIONS
OF PARTICIPANTS
ENGLISH PROFICIENCY
INTENDED LENGTH OF COURSE:
(eg 60 hours over 2 weeks)
DELIVERY MODE
(eg mixed mode - whole group
presentations plus workshops)
AREAS OF INTEREST / TOPICS /
CURRICULUM AREAS YOU
WOULD LIKE TO HAVE
INCLUDED IN THE COURSE
PLEASE INDICATE THE SCOPE
OF THE AREAS OF THE COURSE
YOU HAVE DESIGNED
DO YOU WANT US TO DESIGN A
COURSE TO SUIT YOUR NEEDS?
SPECIAL CONSIDERATIONS
(eg library access; internet access;
catering or anything else that you
need by way of a service from us)