DATA COLLECTION FORM - Academy of Mary Immaculate

STUDENT NAME(Required)

Does the student speak a language other than English at home?

Whether the student only speaks English(Required)

No (English only)

Yes

Student Language(Required)

PARENT 1
Your relationship to student:

Parent/Guardian(A)'s relationship to student(Required)

Mother/Guardian

Father/Guardian

Do you speak a language other than English at home?

Whether Parent/Guardian(A) only speaks English(Required)

No (English only)

Yes

Parent/Guardian(A) Language(Required)

What is the highest year of primary or secondary school you have completed? For persons who have never attended school, please select the box marked *

Parent/Guardian(A) Year Level(Required)

Year 12 or equivalent

Year 11 or equivalent

Year 10 or equivalent

Year 9 or equivalent or below*

What is the level of the highest qualification you have completed?

Parent/Guardian(A) Qualification(Required)

Bachelor degree or above

Advanced diploma/diploma

Certificate I to IV (including trade certificate)

Not Applicable

What is your occupation group - please refer to and select the appropriate Parental Occupation Group from the list.
NOTE:
> If the person is not currently in paid work but has had a job in the last 12 months or has retired in the last 12 months, please use the person’s occupation in the last 6 months.
> If the person has not been in paid work in the last 12 months, select 0 to this question.

Parent/Guardian(A) Occupation Group(Required)

Do you have a Health Care Card? If so, please indicate expiry date. If not applicable leave blank.

Parent/Guardian(A) Health Care Card

YES

Parent/Guardian(A) Health Care Card Expiry(Required)

PARENT 2

Add another Parent/Guardian?

Your relationship to student:

Parent/Guardian(B)'s relationship to student(Required)

Mother/Guardian

Father/Guardian

Do you speak a language other than English at home?

Whether Parent/Guardian(B) only speaks English(Required)

No (English only)

Yes

Parent/Guardian(B) Language(Required)

What is the highest year of primary or secondary school you have completed? For persons who have never attended school, please select the box marked *

Parent/Guardian(B) Year Level(Required)

Year 12 or equivalent

Year 11 or equivalent

Year 10 or equivalent

Year 9 or equivalent or below*

What is the level of the highest qualification you have completed?

Parent/Guardian(B) Qualification(Required)

Bachelor degree or above

Advanced diploma/diploma

Certificate I to IV (including trade certificate)

Not Applicable

Parent/Guardian(B) Occupation Group(Required)

Do you have a Health Care Card? If so, please indicate expiry date. If not applicable leave blank.

Parent/Guardian(B) Health Care Card

YES

Parent/Guardian(B) Health Care Card Expiry(Required)

Acknowledgement/Sign(Required)

Acknowledgement/Sign

Signature(Required)

Signature

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