What are your personal details?
Title:
--Please Select
MR
MS
MISS
MRS
DR
Last Name:
First Given Name:
Telephone Number - Home:
Telephone Number - Work:
Telephone Number - Mobile:
E-mail Address:
Date of Birth:
Sex:
--Please Select
M-Male
F-Female
Where is your usual place of residence?
Address Location - Suburb, Locality or Town:
Postcode:
What is your postal address?
Address First Line:
Address Second Line:
Address Postal - Suburb, Locality or Town:
Postal Postcode:
State Identifier:
--Please Select
01-New South Wales
02-Victoria
03-Queensland
04-South Australia
05-Western Australia
06-Tasmania
07-Northern Territory
08-Australian Capital Territory
09-Other Australian Territories or Dependencies
99-Other (Overseas but not an Australian Territory or Dependency)
Which country were you born in? Country Identifier:
--Please Select
@@@@-Not Specified
0000-Inadequately Described
0001-At Sea
1000-Oceania and Antarctica
1100-Australia (includes External Territories)
1101-Australia
1102-Norfolk Island
1199-Australian External Territories, nec
1201-New Zealand
1300-Melanesia
1301-New Caledonia
1302-Papua New Guinea
1303-Solomon Islands
1304-Vanuatu
1400-Micronesia
1401-Guam
1402-Kiribati
1403-Marshall Islands
1404-Micronesia, Federated States of
1405-Nauru
1406-Northern Mariana Islands
1407-Palau
1500-Polynesia (excludes Hawaii)
1501-Cook Islands
1502-Fiji
1503-French Polynesia
1504-Niue
1505-Samoa
1506-Samoa, American
1507-Tokelau
1508-Tonga
1511-Tuvalu
1512-Wallis and Futuna
1599-Polynesia (excludes Hawaii), nec
1600-Antarctica
1601-Adelie Land (France)
1602-Argentinian Antarctic Territory
1603-Australian Antarctic Territory
1604-British Antarctic Territory
1605-Chilean Antarctic Territory
1606-Queen Maud Land (Norway)
1607-Ross Dependency (New Zealand)
2000-North-West Europe
2100-United Kingdom
2101-Channel Islands
2102-England
2103-Isle of Man
2104-Northern Ireland
2105-Scotland
2106-Wales
2201-Ireland
2300-Western Europe
2301-Austria
2302-Belgium
2303-France
2304-Germany
2305-Liechtenstein
2306-Luxembourg
2307-Monaco
2308-Netherlands
2311-Switzerland
2400-Northern Europe
2401-Denmark
2402-Faeroe Islands
2403-Finland
2404-Greenland
2405-Iceland
2406-Norway
2407-Sweden
3000-Southern and Eastern Europe
3100-Southern Europe
3101-Andorra
3102-Gibraltar
3103-Holy See
3104-Italy
3105-Malta
3106-Portugal
3107-San Marino
3108-Spain
3200-South Eastern Europe
3201-Albania
3202-Bosnia and Herzegovina
3203-Bulgaria
3204-Croatia
3205-Cyprus
3206-Former Yugoslav Republic of Macedonia (FYROM)
3207-Greece
3208-Moldova
3211-Romania
3212-Slovenia
3214-Montenegro
3215-Serbia
3300-Eastern Europe
3301-Belarus
3302-Czech Republic
3303-Estonia
3304-Hungary
3305-Latvia
3306-Lithuania
3307-Poland
3308-Russian Federation
3311-Slovakia
3312-Ukraine
4000-North Africa and the Middle East
4100-North Africa
4101-Algeria
4102-Egypt
4103-Libya
4104-Morocco
4105-Sudan
4106-Tunisia
4107-Western Sahara
4199-North Africa, nec
4200-Middle East
4201-Bahrain
4202-Gaza Strip and West Bank
4203-Iran
4204-Iraq
4205-Israel
4206-Jordan
4207-Kuwait
4208-Lebanon
4211-Oman
4212-Qatar
4213-Saudi Arabia
4214-Syria
4215-Turkey
4216-United Arab Emirates
4217-Yemen
5000-South-East Asia
5100-Mainland South-East Asia
5101-Burma (Myanmar)
5102-Cambodia
5103-Laos
5104-Thailand
5105-Viet Nam
5200-Maritime South-East Asia
5201-Brunei Darussalam
5202-Indonesia
5203-Malaysia
5204-Philippines
5205-Singapore
5206-East Timor
6000-North-East Asia
6100-Chinese Asia (includes Mongolia)
6101-China (excludes SARs and Taiwan Province)
6102-Hong Kong (SAR of China)
6103-Macau (SAR of China)
6104-Mongolia
6105-Taiwan
6200-Japan and the Koreas
6201-Japan
6202-Korea, Democratic People's Republic of (North
6203-Korea, Republic of (South)
7000-Southern and Central Asia
7100-Southern Asia
7101-Bangladesh
7102-Bhutan
7103-India
7104-Maldives
7105-Nepal
7106-Pakistan
7107-Sri Lanka
7200-Central Asia
7201-Afghanistan
7202-Armenia
7203-Azerbaijan
7204-Georgia
7205-Kazakhstan
7206-Kyrgyz Republic
7207-Tajikistan
7208-Turkmenistan
7211-Uzbekistan
8000- Americas
8100-Northern America
8101-Bermuda
8102-Canada
8103-St Pierre and Miquelon
8104-United States of America
8200-South America
8201-Argentina
8202-Bolivia
8203-Brazil
8204-Chile
8205-Colombia
8206-Ecuador
8207-Falkland Islands
8208-French Guiana
8211-Guyana
8212-Paraguay
8213-Peru
8214-Suriname
8215-Uruguay
8216-Venezuela
8299-South America, nec
8300-Central America
8301-Belize
8302-Costa Rica
8303-El Salvador
8304-Guatemala
8305-Honduras
8306-Mexico
8307-Nicaragua
8308-Panama
8400-Caribbean
8401-Anguilla
8402-Antigua and Barbuda
8403-Aruba
8404-Bahamas
8405-Barbados
8406-Cayman Islands
8407-Cuba
8408-Dominica
8411-Dominican Republic
8412-Grenada
8413-Guadeloupe
8414-Haiti
8415-Jamaica
8416-Martinique
8417-Montserrat
8418-Netherlands Antilles
8421-Puerto Rico
8422-St Kitts and Nevis
8423-St Lucia
8424-St Vincent and the Grenadines
8425-Trinidad and Tobago
8426-Turks and Caicos Islands
8427-Virgin Islands, British
8428-Virgin Islands, United States
9000-Sub-Saharan Africa
9100-Central and West Africa
9101-Benin
9102-Burkina Faso
9103-Cameroon
9104-Cape Verde
9105-Central African Republic
9106-Chad
9107-Congo
9108-Congo, Democratic Republic of
9111-Cote d'Ivoire
9112-Equatorial Guinea
9113-Gabon
9114-Gambia
9115-Ghana
9116-Guinea
9117-Guinea-Bissau
9118-Liberia
9121-Mali
9122-Mauritania
9123-Niger
9124-Nigeria
9125-Sao Tome and Principe
9126-Senegal
9127-Sierra Leone
9128-Togo
9200-Southern and East Africa
9201-Angola
9202-Botswana
9203-Burundi
9204-Comoros
9205-Djibouti
9206-Eritrea
9207-Ethiopia
9208-Kenya
9211-Lesotho
9212-Madagascar
9213-Malawi
9214-Mauritius
9215-Mayotte
9216-Mozambique
9217-Namibia
9218-Reunion
9221-Rwanda
9222-St Helena
9223-Seychelles
9224-Somalia
9225-South Africa
9226-Swaziland
9227-Tanzania
9228-Uganda
9231-Zambia
9232-Zimbabwe
9299-Southern and East Africa, nec
Do you speak a language other than English at home?
No, English only:
Main Language other than English Spoken at Home Identifier:
--Please Select
@@@@-Not Stated
0000-Unknown
0001-Non Verbal
0003-Swiss, so described
0004-Cypriot, so decribed
0005-Creole
0006-French Creole
0007-Spanish Creole
0008-Portuguese Creole
0009-Pidgin
1000-NORTHERN EUROPEAN LANGUAGES
1100-Celtic
1101-Gaelic (Scotland)
1102-Irish
1103-Welsh
1199-Celtic, nec
1201-English
1300-German and Related Languages
1301-German
1302-Letzeburgish
1303-Yiddish
1400-Dutch and Related Languages
1401-Dutch
1402-Frisian
1403-Afrikaans
1500-Scandinavian
1501-Danish
1502-Icelandic
1503-Norwegian
1504-Swedish
1599-Scandinavian, nec
1600-Finnish and Related Languages
1601-Estonian
1602-Finnish
1699-Finnish and Related Languages, nec
2000-SOUTHERN EUROPEAN LANGUAGES
2101-French
2201-Greek
2300-Iberian Romance
2301-Catalan
2302-Portuguese
2303-Spanish
2399-Iberian Romance, nec
2401-Italian
2501-Maltese
2900-Other Southern European Languages
2901-Basque
2902-Latin
2999-Other Southern European Languages, nec
3000-EASTERN EUROPEAN LANGUAGES
3100-Baltic
3101-Latvian
3102-Lithuanian
3301-Hungarian
3400-East Slavic
3401-Belorussian
3402-Russian
3403-Ukrainian
3500-South Slavic
3501-Bosnian
3502-Bulgarian
3503-Croatian
3504-Macedonian
3505-Serbian
3506-Slovene
3507-Serbo-Croatian/Yugoslavian, so described
3600-West Slavic
3601-Czech
3602-Polish
3603-Slovak
3900-Other Eastern European Languages
3901-Albanian
3903-Aromunian (Macedo-Romanian)
3904-Romanian
3905-Romany
3999-Other Eastern European Languages, nec
4000-SOUTHWEST AND CENTRAL ASIAN LANGUAGES
4100-Iranic
4101-Kurdish
4102-Pashto
4104-Balochi
4105-Dari
4106-Persian (excluding Dari)
4199-Iranic, nec
4200-Middle Eastern Semitic Languages
4202-Arabic
4203-Assyrian
4204-Hebrew
4299-Middle Eastern Semitic Languages, nec
4300-Turkic
4301-Turkish
4302-Azeri
4303-Tatar
4304-Turkmen
4305-Uygur
4306-Uzbek
4399-Turkic, nec
4900-Other Southwest and Central Asian Languages
4901-Armenian
4902-Georgian
4999-Other Southwest and Central Asian Languages,
5000-SOUTHERN ASIAN LANGUAGES
5100-Dravidian
5101-Kannada
5102-Malayalam
5103-Tamil
5104-Telugu
5105-Tulu
5199-Dravidian, nec
5200-Indo-Aryan
5201-Bengali
5202-Gujarati
5203-Hindi
5204-Konkani
5205-Marathi
5206-Nepali
5207-Punjabi
5208-Sindhi
5211-Sinhalese
5212-Urdu
5213-Assamese
5214-Dhivehi
5215-Kashmiri
5216-Oriya
5299-Indo-Aryan, nec
5999-Other Southern Asian Languages
6000-SOUTHEAST ASIAN LANGUAGES
6100-Burmese and Related Languages
6101-Burmese
6102-Haka
6103-Karen
6199-Burmese and Related Languages, nec
6200-Hmong-Mien
6201-Hmong
6299-Hmong-Mien, nec
6300-Mon-Khmer
6301-Khmer
6302-Vietnamese
6303-Mon
6399-Mon-Khmer, nec
6999-Other Southeast Asian Languages
6400-Tai
6401-Lao
6402-Thai
6499-Tai, nec
6500-Southeast Asian Austronesian Languages
6501-Bisaya
6502-Cebuano
6503-IIokano
6504-Indonesian
6505-Malay
6507-Tetum
6508-Timorese
6511-Tagalog
6512-Filipino
6513-Acehnese
6514-Balinese
6515-Bikol
6516-Iban
6517-Ilonggo (Hiligaynon)
6518-Javanese
6521-Pampangan
6599-Southeast Asian Austronesian Languages, nec
7000-EASTERN ASIAN LANGUAGES
7100-Chinese
7101-Cantonese
7102-Hakka
7103-Hokkien
7104-Mandarin
7105-Teochew
7106-Wu
7199-Chinese, nec
7201-Japanese
7301-Korean
7900-Other Eastern Asian Languages
7901-Tibetan
7902-Mongolian
7999-Other Eastern Asian Languages, nec
8000-AUSTRALIAN INDIGENOUS LANGUAGES
8100-Arnhem Land and Daly River Region Languages
8101-Anindilyakwa
8102-Burarra
8108-Kunwinjku
8111-Maung
8113-Ngan'gikurunggurr
8114-Nunggubuyu
8115-Rembarrnga
8117-Tiwi
8121-Alawa
8122-Dalabon
8123-Gudanji
8124-Gundjeihmi
8125-Gun-nartpa
8126-Gurr-goni
8127-Iwaidja
8128-Jaminjung
8131-Jawoyn
8132-Jingulu
8133-Kunbarlang
8134-Kune
8135-Kuninjku
8136-Larrakiya
8137-Malak Malak
8138-Mangarrayi
8141-Maringarr
8142-Marra
8143-Marrithiyel
8144-Matngala
8145-Mayali
8146-Murrinh Patha
8147-Na-kara
8148-Ndj
8151-Ngalakgan
8152-Ngaliwurru
8153-Nungali
8154-Wambaya
8155-Wardaman
8199-Arnhem Land and Daly River Region Languages,
8200-Yolngu Matha
8210-Dhangu
8211-Galpu
8212-Golumala
8213-Wangurri
8219-Dhangu, nec
8220-Dhay'yi
8221-Dhalwangu
8222-Djarrwark
8229-Dhay'yi, nec
8230-Dhuwal
8231-Djambarrpuyngu
8232-Djapu
8233-Daatiwuy
8234-Marrangu
8235-Liyagalawumirr
8239-Dhuwal, nec
8240-Dhuwala
8241-Dhuwaya
8242-Gumatj
8243-Gupapuyngu
8244-Guyamirrilili
8245-Madarrpa
8246-Manggalili
8247-Wubulkarra
8249-Dhuwala, nec
8250-Djinang
8251-Wurlaki
8259-Djinang, nec
8260-Djinba
8261-Ganalbingu
8269-Djinba, nec
8270-Yakuy
8271-Ritharrngu
8279-Yakuy, nec
8280-Nhangu
8281-Nhangu
8290-Other Yolngu Matha
8299-Other Yolngu Matha
8300-Cape York Peninsula Languages
8301-Kuku Yalanji
8302-Guugu Yimidhirr
8303-Kuuku-Ya'u
8304-Wik Mungkan
8305-Djabugay
8306-Dyirbal
8307-Girramay
8308-Koko-Bera
8311-Kuuk Thayorre
8312-Lamalama
8313-Yidiny
8314-Wik Ngathan
8399-Cape York Peninsula Languages, nec
8400-Torres Strait Island Languages
8401-Kalaw Kawaw Ya/Kalaw Lagaw Ya
8402-Meriam Mir
8403-Torres Strait Creole
8500-Northern Desert Fringe Area Languages
8504-Bilinarra
8505-Gurindji
8506-Gurindji Kriol
8507-Jaru
8508-Light Warlpiri
8511-Malngin
8512-Mudburra
8513-Ngandi
8514-Ngardi
8515-Ngarinyman
8516-Walmajarri
8517-Wanyjirra
8518-Warlmanpa
8521-Warlpiri
8522-Warumungu
8599-Northern Desert Fringe Area Languages, nec
8600-Arandic
8603-Alyawarr
8604-Anmatyerr
8605-Arrernte
8606-Kaytetye
8699-Arandic, nec
8700-Western Desert Language
8703-Antikarinya
8704-Kartujarra
8705-Kukatha
8706-Kukatja
8707-Luritja
8708-Manyjilyjarra
8711-Martu Wangka
8712-Ngaanyatjarra
8713-Pintupi
8714-Pitjantjatjara
8715-Wangkajunga
8716-Wangkatha
8717-Warnman
8718-Yankunytjatjara
8721-Yulparija
8799-Western Desert Language, nec
8800-Kimberley Area Languages
8801-Bardi
8802-Bunuba
8803-Gooniyandi
8804-Miriwoong
8805-Ngarinyin
8806-Nyikina
8807-Worla
8808-Worrorra
8811-Wunambal
8812-Yawuru
8899-Kimberley Area Languages, nec
8900-Other Australian Indigenous Languages
8901-Adnymathanha
8902-Arabana
8903-Bandjalang
8904-Banyjima
8905-Batjala
8906-Bidjara
8907-Dhanggatti
8908-Diyari
8911-Gamilaraay
8912-Garrwa
8913-Garuwali
8914-Githabul
8915-Gumbaynggir
8916-Kanai
8917-Karajarri
8918-Kariyarra
8921-Kaurna
8922-Kayardild
8923-Kija
8924-Kriol
8925-Lardil
8926-Mangala
8927-Muruwari
8928-Narungga
8931-Ngarluma
8932-Ngarrindjeri
8933-Nyamal
8934-Nyangumarta
8935-Nyungar
8936-Paakantyi
8937-Palyku/Nyiyaparli
8938-Wajarri
8941-Wiradjuri
8942-Yanyuwa
8943-Yindjibarndi
8944-Yinhawangka
8945-Yorta Yorta
8998-Aboriginal English, so described
8999-Other Australian Indigenous Languages, nec
9000-OTHER LANGUAGES
9101-American Languages
9200-African Languages
9201-Acholi
9203-Akan
9205-Mauritian Creole
9206-Oromo
9207-Shona
9208-Somali
9211-Swahili
9212-Yoruba
9213-Zulu
9214-Amharic
9215-Bemba
9216-Dinka
9217-Ewe
9218-Ga
9221-Harari
9222-Hausa
9223-Igbo
9224-Kikuyu
9225-Krio
9226-Luganda
9227-Luo
9228-Ndebele
9231-Nuer
9232-Nyanja (Chichewa)
9233-Shilluk
9234-Tigr
9235-Tigrinya
9236-Tswana
9237-Xhosa
9238-Seychelles Creole
9299-African Languages, nec
9300-Pacific Austronesian Languages
9301-Fijian
9302-Gilbertese
9303-Maori (Cook Island)
9304-Maori (New Zealand)
9305-Motu
9306-Nauruan
9307-Niue
9308-Samoan
9311-Tongan
9312-Rotuman
9313-Tokelauan
9314-Tuvaluan
9315-Yapese
9399-Pacific Austronesian Languages, nec
9400-Oceanian Pidgins and Creoles
9401-Tok Pisin
9402-Bislama
9403-Hawaiian English
9404-Pitcairnese
9405-Solomon Islands Pijin
9499-Oceanian Pidgins and Creoles, nec
9500-Papua New Guinea Papuan Languages
9502-Kiwai
9599-Papua New Guinea Papuan Languages, nec
9601-Invented Languages
9700-Sign Languages
9701-Auslan
9702-Makaton
9799-Sign Languages, nec
How well do you speak English?
Proficiency in Spoken English Identifier:
--Please Select
1-Very well
2-Well
3-Not well
4-Not at all
Are you of Aboriginal or Torres Strait Islander origin?
Indigenous Status Identifier:
--Please Select
1-Yes, Aboriginal
2-Yes, Torres Strait Islander
3-Yes, Aboriginal AND Torres Strait Islander
4-No, Neither Aboriginal nor Torres Strait Islander
9-Yes, Client is of Aboriginal / or Torres Strait Islander origin
Do you consider yourself to have a disability, impairment or long-term condition?
Disability Flag:
--Please Select
Y-Yes - the client has a disability, impairment or long-term condition
N-No - the client does not have a disability, impairment or long-term condition
If YES, then please indicate the area of disability, impairment or long-term condition:
Disability Type Identifier:
--Please Select
11-Hearing/Deaf
12-Physical
13-Intellectual
14-Learning
15-Mental Illness
16-Acquired Brain Impairment
17-Vision
18-Medical Condition
19-Other
99-Not Specified
What are your previous schooling details?
Highest School Level Completed:
--Please Select
02-Did not go to school
08-Year 8 or below
09-Year 9 or equivalent
10-Completed Year 10
11-Completed Year 11
12-Completed Year 12
In which YEAR did you complete that school level?
Year Highest School Level Completed:
Are you still attending secondary school?
At School Flag:
--Please Select
Y-Yes - the client is still attending secondary school
N-No - the client is not attending secondary school
Have you successful completed any of the following Qualifications?
Prior Educational Achievement Flag:
--Please Select
Y-Yes - a prior educational achievement has been successfully completed
N-No - a prior educational achievement has not been successfully completed
If YES, then select below:
Prior Educational Achievement Identifier:
--Please Select
008-Bachelor Degree or Higher Degree
410-Advanced Diploma or Associate Degree
420-Diploma (or Associate Diploma)
511-Certificate IV (or Advanced Certificate/Technician)
514-Certificate III (or Trade Certificate)
521-Certificate II
524-Certificate I
990-Certificates other than the above
Of the following categories, which BEST describes your current employment status?
Labour Force Status Identifier:
--Please Select
01-Full-time employee
02-Part-time employee
03-Self-employed - not employing others
04-Employer
05-Employed - unpaid worker in a family business
06-Unemployed - seeking full-time work
07-Unemployed - seeking part-time work
08-Not employed - not seeking employment
Why have you chosen to study?
Study Reason Identifier:
--Please Select
01-To get a job
02-To develop my existing business
03-To start my own business
04-To try a different career
05-To get a better job or promotion
06-It was a requirement of my job
07-I wanted extra skills for my job
08-To get into another course of study
11-Other reasons
12-For personal interest or self-development
Do you have a Learner Unique Identifier?
Learner Unique Identifier: