We are required by our funding body to include the following information in our statistical returns to the Federal Government. Information is treated as strictly confidential at all times.

You may be surveyed at a later date to help the government determine your level of satisfaction with the service you received.

No personal information from data collection is used for any other purpose except as required by law.

Victorian Student Number

I do not know my Victorian Student Number but I have attended a Victorian school, TAFE or other Training Provider.

Are you new to the Victorian Education System?

I have never attended a Victorian school, TAFE or other Training Provider.

Date Of Birth:


  • M
  • F

Are you of Aboriginal or Torres Strait Islander Origin:

  • yes
  • no

Employment Category (please tick one)

  • Full Time Paid Employee

    Part Time Paid Employee

    Self Employed – Not employing Others

  • Employer

    Employed – Unpaid Family Worker

    Unemployed – Seeking Full Time Work

  • Unemployed – Seeking Part Time Work

    Not Employed – Not Seeking Paid Work

Country of Birth

Language Spoken at Home:

If you speak a language other than English at home, how well do you speak English?

  • Very Well

  • Well

  • Not Well

  • Not at All

What is your Highest Completed School Level:

  • Year 7

  • Year 8

  • Year 9

  • Year 10

  • Year 11

  • Year 12

  • Special School

  • Did not attend School

Which Year did you complete that level of school?

Are You still Attending School?

  • yes
  • no

Have you completed any Further Education? (please tick)

  • Batchelor Degree or Post Graduate Qual.

    Advanced Diploma or Assoc Degree


  • Certificate 4

    Certificate 3 or Trade Certificate

    Certificate 2

  • Certificate 1


What is your reason for enrolling in this course? (please Tick)

  • For personal interest

    I wanted extra skills for my job

    it was a requirement of my job

  • to start my own business

    to develop my existing business

    to get into another course of study

  • to get a better job or promotion

    to try for a different career

    for self development

Do you consider yourself to have a disability, impairment or long term condition?

  • yes
  • no

If YES, please tick which area/s of disability, impairment or long term condition:

  • Hearing/ Deaf

    Medical Condition


  • Intellectual



  • Acquired Brain Impairment

    Mental Illness

Is there anything we can do to support your participation in this class? (eg notes in Large Print etc)

May we pass this information on to the tutor, to be used in an emergency

  • yes
  • no

Are You an Australian Citizen?

  • yes
  • no

*If NO Are you a Permanent Resident of Australia?

  • yes
  • no

Do you have a Temporary Protection Visa?

  • yes
  • no

If You have answered No to all of the above questions you are not eligible for a Government Funded place.

Do you hold any of the following Concession cards?

  • Commonwealth Health Care Card
  • Pensioner Concession
  • Veteran’s gold card

Card Number:


Expiry Date: