JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Element Set Expansion Pack order form
Use this form to order an 'Expansion Pack' for an Element Set distributed in 2019. Contents include new samples (Ge, Hf, Y, Gd, Ho), an improved Mg sample, and an updated booklet.
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
Contact and Address Details
Name
*
Your answer
Position
*
Teacher
Laboratory technician
Other:
Required
School Name
*
Your answer
School Street Address
*
Your answer
School Postal Address
*
Your answer
School Demographics
Please answer the following demographic questions, which will help us analyse where the sets are going, and assist with meeting any varied state and sector requirements as they arise.
State
*
ACT
NSW
NT
Qld
SA
Tas
Vic
WA
School Sector
*
Government
Catholic
Independent
School Location
*
Capital City
Large Regional Centre (Gold Coast/Tweed Heads, Newcastle, Sunshine Coast, Central Coast, Wollongong, Geelong, Townsville, Cairns, Toowoomba, Ballarat, Bendigo, Albury/Wodonga, Launceston, Mackay, Rockhampton, Bunbury, Bundaberg, Coffs Harbour)
Rural or Smaller Regional City
Remote
Feedback
Feedback on how your Element Set is currently being used would be greatly appreciated.
Previous feedback was essential to both justifying the funding and work that went into the first round of sets, and for making the second round of sets (and the expansion packs for the first round sets) a viable prospect, both in terms of obtaining new sponsorship funding and sample donations, and in investing the very significant time and effort required in producing each handmade set.
How many students a year do you estimate are engaging with your Element Set?
Your answer
Any other feedback?
Your answer
Any photos of the sets in use or on display, class plans or other useful documents would be greatly appreciated, and can be emailed to
stuart.batten@monash.edu
.
Please also indicate in your email if it is OK to share the photos & class plans on e.g. the project website (
elementsets.net
), social media (e.g.
#elementsets on Twitter
), project reports, future funding requests, etc. This sharing of element sets "in the wild" is vital to the ongoing promotion and success of the project.
Final Sign-off
Due to the large number, there may be some delay before your Expansion Pack is sent, so please be patient. Please also let me know (at stuart.batten@monash.edu) when they do arrive safely, and if anything gets damaged in transit.
Handover
*
I agree to take all responsibility for the safety, storage and proper handling of the set, both in and out of the classroom.
I will download and consult both the Teachers' Notes and the SDSs available on the
elementsets.net
website before using the set.
I will glue the lids on each sample container, as per the instructions in the Teachers' Notes. It is ESSENTIAL that these instructions are followed closely to avoid damaging the containers.
I agree that should I leave the School listed above, both the set and the expansion back will remain behind at the school it was donated to.
Required
A copy of your responses will be emailed to the address you provided.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
Privacy
Terms
This form was created inside of Monash University.
Does this form look suspicious?
Report
Forms
Help and feedback
Help Forms improve
Report
