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What Is A Cochlear Implant?
What Is Crohn’s Disease?
What is Dementia?
What is Epilepsy?
What Is Hearing Impairment?
What Is Urinary Incontinence?
What Is Inflammatory Bowel Disease?
What is Parkinson’s Disease?
What is a Stroke?
What is Retinitis Pigmentosa?
What is Rheumatoid Arthritis?
What Is Tinnitus?
What is Type 2 Diabetes?
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2024 Bionics Institute Girls in STEM School Form
School
(Required)
Coodinating Teacher's Name
(Required)
First
Last
Teacher's email address
(Required)
Students from your school may be allocated to different mentors at different institutions depending on their preferred subject area. Please indicate whether this is acceptable or not.
(Required)
Yes
No
Please note if you prefer your students to be allocated to mentors from the same institution students may not get their subject area preferences.
Interest area
Please select
Bioengineering
Bionic limbs
Hearing
Histology
Mental health
Neuroscience
Tinnitus
Indicating your students’ interest area will assist with matching; however, we cannot guarantee you will receive your preferred STEM area.
I would be interested in my students attending a session in person with their mentor in 2024 (To be coordinated between the school and mentor)
(Required)
Yes
No
I would like my students to receive an invitation to attend the Bionics Institute Open House Event on 14 August 2024, to see researchers in action across the Institute. (Please note this is not mandatory but students will benefit from attending.
(Required)
Yes
No
My students commit to attending five 20 minute online mentoring sessions with their mentor between May and October and conducting Google research as directed by the mentor for discussion in each session. Please note, your school cannot participate without agreement.
(Required)
Yes
No
The preferred date for me to organise for my students to present their learnings at an all school/year level/class assembly is as follows. Please note, this should take place before 30 October.
(Required)
I would like my students to receive an invitation to attend a Girls in STEM Certificate Presentation event in October. Please note this is not mandatory, but will benefit the students.
(Required)
Yes
No
All mentors will be asked to provide a Working With Children Check. Please indicate if you wish to be sent a copy of the WWCC for your students' mentors.
(Required)
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No
Student contact details and preferences
Maximum 4 students per school
Student #1 Name
(Required)
First
Last
Student #1 Email
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Student #1 Consent Form
Max. file size: 50 MB.
Student #2 Name
First
Last
Student #2 Email
Student #2 Consent Form
Max. file size: 50 MB.
Student #3 Name
First
Last
Student #3 Email
Student #3 Consent Form
Max. file size: 50 MB.
Student #4 Name
First
Last
Student #4 Email
Student #4 Consent Form
Max. file size: 50 MB.
Privacy
I agree to the terms and conditions of the program
I agree to the terms and conditions of the 2024 Bionics Institute Girls in STEM program
I understand all information submitted via this form will be handled in accordance with the
Bionics institute privacy statement.
Students and teachers agree to email communications from the Bionics Institute
I authorise the Bionics Institute to take, edit and use information, photos, audio clips and video clips of mentors and students for marketing purposes (print, online, external sources).
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