Course / class name
Other or not applicable
A Taste of the Mediterranean Astrology Made Simple and Easy Basic Italian Beginners Fitball Pilates Bicycle Maintenance Blokes in the Kitchen Book Discussion Group Card Games Social Group Cardinia Bicycle User Group (BUG) Cardinia Wanderers Walking Group Christmas Sweets and Treats Community Forum: Cardinia Shire Council – Car Parking Strategy for Pakenham Town Centre Computer Maintenance and Internet Safety Create Your Own Website (Using WordPress) Disability Awareness Disability Awareness Easy Exercise and Relaxation (DRU YOGA) Explore a career in the Community Services Sector Facebook for Seniors (iPad Based) Food Hygiene for Handlers (SITXFS001) Free Counselling Sessions Free Legal Advice Functional Fitness for Over 50s Fundraising Morning Tea in support of White Ribbon Gardening Group Excursion: Cranbourne Australian Botanical Gardens Gardening Group Meetings Intermediate Italian Intermediate Microsoft Word Introduction / Learn To Play The Ukulele Introduction to Ayurveda (Indian Herbal Medicine) Introduction to Computers Introduction to Microsoft Excel Introduction to MYOB iPad for Beginners Italian Language (Intermediate Level 2) Knit and Knatter Learn Tarot the Easy Way Market Place Marchers Walking Group Mat Pilates MEDITATION Men’s Discussion Group Men’s Strength Training Microsoft Excel – The Next Step Microsoft Office – Word, Excel, Publisher Microsoft Publisher for Beginners MYOB Payroll Over 50s Pilates/Low Impact Strength Training Over 50s Womens Friendship Group Provide an Emergency First Aid Response in an Education and Care Setting (HLTAID004) Provide CPR (HLTAID001) Provide First Aid (HLTAID003) Recreational Boat Licence Responsible Serving of Alcohol (RSA Vic) Safe Travelling in your Caravan or 4 x 4 Tai Chi Technology Savvy Seniors Toomuc Valley Walking Group U-Bute Ukulele Group Windows 10 ZUMBA Fitness ‘All Together’ Choir
Course / class name (if not in the list above)
Course / class date and time (if applicable)
Emergency contact name
Emergency contact phone
Emergency contact relationship
Date of birth (DD/MM/YYYY)
Gender (Please select one)
Self employed (not employing others)
Employed – unpaid family worker
Unemployed – seeking full time work
Unemployed – seeking part time work
Unemployed – not seeking employemnt
Country of birth (if not Australia)
Town / City of birth
Do you speak a language other than English at home?
If English is not your first language, how well do you speak English?
Not at all
Are you of Aboriginal or Torres Strait Islander Origin?
Yes - Aboriginal
Yes - Torres Strait Islander
Do you consider yourself to have a disability, impairment or long-term condition?
Acquired Brain Injury
Other (eg Epilepsy, Heart condition, Allergies, Kidney condition)
What is your highest COMPLETED school level?
Year 9 or equivalent
Year 8 or lower
Did not go to school
In which year did you complete that school level?
Are you still attending secondary school?
Have you SUCCESSFULLY completed any of the following qualifications?
Bachelor Degree or Higher Degree
Certificate III (or Trade Certificate)
Advanced Diploma or Associate Diploma
Certificate IV (or Advanced Cert/Technician)
What kind of qualification do you hold?
Australian qualification (A)
Australian equivalent (E)
Reason for studying?
` To get a job
To try for a different career
I wanted extra skills for my job
For personal interest or self development
To develop my existing business
To get a better job or promotion
To get into another course or study
To start my own business
It was a requirement of my job
Which industry area are you employed in?
Not currently employed
Agriculture, forestry & fishing (A)
Electricity, gas, water and waste service (D)
Wholesale Trade (F)
Retail Trade (G)
Accommodation & Food services (H)
Transport Postal & Warehouse (I)
Information, Media & Telecommunication (J)
Financial & Insurance Services (K)
Rental, hiring & Real estate services (L)
Professional, scientific & technical services (M
Administrative & Support services (N)
Public administration & safety (O)
Education & Training (P)
Health Care & social assistance (Q)
Art & recreation services (R)
Other services (S)
Occupation type identified
Technicians & Trade workers (3)
Community & personal services (4)
Clerical & Administrative worker (5)
Sales worker (6)
Machinery operator & drivers (7)