Application form

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Please use the online form below or download a PDF version of our application form. Then simply email or post the completed form to us.

The Department of Education through Jacobs Well Environmental Education Centre is collecting personal information in accordance with Education (General Provisions) Act 2006 in order to process your application. The information will only be accessed by employees of the Department of Education. The information will not be given to any other person or agency unless prior consent is obtained.

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School *

Street Address *

City *

State/Province *

Business Phone *

Mobile Number

Contact name/s *

Contact email address/es *

Year level *

Subject / KLA *

Numbers of staff *

Numbers of students *

We wish to apply for a *

Number of days

Number of nights

Preferred excursion dates *

The dates we CANNOT attend

Programs

Please nominated the programs that you would like incorporated into your excursion or camp. A description of our programs can be found on our website.

Curriculum focus

Jacobs Well EEC programs are linked to the Australian National Curriculum and QCAA. Please indicate the curriculum focus for your excursion or camp. Note: If your application is successful, our staff will discuss specific program details with you prior to your excursion.

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