Expression of Interest Form

Expression of Interest Form

Speech Pathology Services for Schools, Kindergartens & Childcare Centres
Thank you for your interest in our school-based speech pathology services. Please complete the form below, and our team will contact you to discuss how we can support your students.
Centre Information

SchoolKindergartenChildcare CentreOther
Name of School/Kindergarten/Childcare Centre
Address
Best Contact Person
Position
Phone Number
Email Address
Services Required (Please check all that apply)

School-Based Speech Pathologist (Regular or scheduled visits)Speech and Language AssessmentsScreening Assessments (Identifying students needing further support)Individual Therapy for Students (On-site visits)Group Therapy SessionsTeacher and Staff Training/WorkshopsConsultation and Classroom SupportOther
Days of week service required

Monday MorningTuesdayWednesdayThursdayFriday
Additional Information (Please provide any details about specific needs, student concerns or preferred scheduling)
Should be Empty: