School Information and Contact Details

School Name

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Contact Name

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School Street Address

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City / Town / Village

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County

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Contact Number

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I am a ...

This form must be completed by a school official / member of staff, who has the permission of School Management to make a formal request for an AsIAm Workshop. Please select your position (or most relevant position) below

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Details of Request

This information relates to the age group for the workshop, size and number of classes

Number of Classes requesting workshop

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Group Size

The maximum number of students for our workshop is 35

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Days suitable to host a workshop (please select all the apply)

This will enable us to see if we can match a local speaker to your school

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Suitable times

Our workshop last 90 minutes. Please type below, suitable class times on the days you have indicated.

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Months / Holiday periods unsuitable to host a workshop

Please detail below any specific dates, holidays or time periods which you cannot host a workshop

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Reason for Requesting Workshop

Why would you like an AsIAm Workshop in your school?

General awareness / understanding of Autism
New / existing Autism class within school
Part of programme of inclusion / awareness week
Challenges / concerns of a specific student(s) with Autism
New student with Autism
Student with Autism entering transition year
Other:

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AsIAm Secondary School Workshop - School Request Form

School Information and Contact Details

Details of Request

Reason for Requesting Workshop