AASSA Consultant Search Service Request Form

Date* (mm/dd/yyyy)

Name of School*

Location (City, Country, etc.)*

School Phone Number*

Name of Person Making Request*

Position of Person Making Request*

Email Address of Person Making Request*

Name of Head of School (HOS)*

Email Address of HOS*

Name of Main Contact / Workshop Coordinator*

Email Address of Main Contact / Workshop Coordinator*

Subject Area / Specific Topic / Need*

Length of Consultancy (# of Days)*

Proposed Workshop Date - From:* (mm/dd/yyyy)

Proposed Workshop Date - To:* (mm/dd/yyyy)

Proposed Travel Dates for Consultant (To and From Host School)*

Audience (Teachers, Staff, IT, etc.)*

Approximate # of Participants*

Facilities Available for Workshop Use*

Please include any additional information (below) you consider pertinent for potential consultants and AASSA to know:

Please send a confirmation email to the address below*:

Please provide an email address where we can send a link to your current form.

Email Address :