HSCM 2020 Expression of Interest Form
This form is for teachers to express their school and students' interest in participating in the ACHSC's 2020 High School Cancer Masterclasses program.

Please complete and submit this form by 11:59 PM Sunday 7th June (07/06/20) to be considered for the 2020 program. We will do our best to accommodate you and your students' preferences.

For more information regarding ACHSC, HSCM or other initiatives please visit our:
• Website: http://www.achsc.org.au/
• Facebook page: https://www.facebook.com/cancercompetition/
• Send us an email: vic_hscm@achsc.org.au.

NB: our organising team is based in Victoria; if your school is in NSW or QLD, please direct enquiries to the vic_hscm@achsc.org.au email as well.
Name of school *
Teacher title *
Please provide details of the most appropriate teacher for the ACHSC to contact
First name *
Please provide details of the most appropriate teacher for the ACHSC to contact
Surname *
Please provide details of the most appropriate teacher for the ACHSC to contact
Title / official position / role at school *
Please provide details of the most appropriate teacher for the ACHSC to contact e.g. head of VCE 3/4 biology, Yr 10 science teacher, etc.
Email address *
Please provide a regularly-checked email address of the most appropriate teacher for the ACHSC to contact.
Telephone number *
Please provide details of the most appropriate teacher for the ACHSC to contact. A personal mobile phone number is preferred; alternatively please provide a landline number with the appropriate extension number.
School postal address *
Please provide your school's full postal address e.g. 1 School St, Suburbia, Victoria 3126
Is your school interested in participating in the 2020 High School Cancer Masterclasses program? *
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