Teacher Referral

Please use the URL provided by your student when accessing this page

This form should take you less than 10 minutes and needs to be submitted to complete your student’s application. Please provide evidence in support of your recommendation

"*" indicates required fields

Your details

School name*

Your name (Teacher)*

Prefix First Last

Your contact number*

If landline, include area code

Your email*

Student details

Student name*

First Last

Student year level in 2025*

Please provide comments in relation to the student’s effort and application*

E.g. are they inquisitive, how do they display a positive attitude to learning, etc.?

Please provide comments in relation to the student’s social skills and maturity*

E.g. do they usually get along well with other students, are they a team player, are they likely to share their experiences back at school in a positive way (e.g. talk about it in assembly), etc.?

In your opinion does this student have the maturity and willingness to engage productively with a coach?*

As part of the program students will be matched to a female STEM coach.

Do you feel this student has the determination to commit to this program, including a December residential camp and a July virtual camp as well as the coaching program?*

Do you think the student can sustain their focus over an extended period (i.e. can they complete a project)?

Please provide comments in relation to barriers to learning this student may face, or special assistance they may require, if invited to attend*

Please provide any other relevant comments about this student*