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Qualification Name:
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Student Name:
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Home address:
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Work address:
Number and street
Suburb and postcode
Supervisor name:
Supervisor email:
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Work phone:
Work fax:
Home phone:
Mobile:
Student email contact:
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3. Date of birth
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4. Sex (tick one box)
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5. Ethnicity/Aboriginality (tick one
box)
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Day, month, year
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Male 
Female
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Are you of Aboriginal/Torres Strait islander origin?
Yes No
Were you born in Australia?
Yes No
If
not, specify country of birth:
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6. Schooling (tick one box)
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7. Language (tick one box)
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What is your highest completed school level?
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Year 12
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Year 11
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Year 10
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Year 9
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Year 8
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Year 7 or lower
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In which year did you complete that school level?
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Do you speak a language other than English at home?
Yes No
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8. Prior achievements
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9. Employment (tick one box)
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Since leaving school have you successfully completed any
qualifications?
Yes
No
If yes, tick any applicable boxes:
Trade certificate
Advanced/Technician certificate
Advanced diploma
Undergraduate diploma
Degree or Postgraduate Diploma
Certificates other than those above (Please specify)
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Of the following categories which best describes your current
employment status? (Tick one box)
Full time employee (more than 30 hours per week)
Part time employee (less than 30 hours per week)
Self employed (no employees)
Employer
Unemployed (seeking full time work)
Unemployed (seeking part time work)
Unemployed (unpaid family worker)
Unemployed (not seeking word)
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10. Disability (tick appropriate box)
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11. Citizenship (tick one box)
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Do you consider yourself to have a permanent and significant
disability?
Yes No
If yes, specify type of disability:
Do you require special assistance because of the disability?
Yes No
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Student Declaration.
I am:
an Australian
a New Zealand citizen
an Australian permanent
or a temporary resssident
none of the above
Please specify:
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NOTE: The information requested in this form will be used
by DET for research, statistical and internal management purposes
only. In supplying the requested information, the participant
is deemed to have consented to the use of the information
for those purposes.
Participant's signature
Date
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