Other (please specify): ______________________________
What is your background?
Australian
English
Indian
Scottish
Irish
Other (please specify):______________________________
Where was your country of birth?
Australia
India
Sri Lanka
England
Philipines
Other (please specify):______________________________
What language is spoken at home?
English
Tamil
Hindi
Arabic
Punjabi
Cantonese
Other (please specify):______________________________
What is your work status?
Part time Employment
Full Time work
Away from work
Unemployed
What is your family make up?
Couple family without children
Couple family with children
One parent family
Other family
What is your highest completed education status?
Never went to school
6-10 years old
11-16 years old
Completed University
Attended TAFE/Trade schooling
What type of house do you live in?
Owned outwright
Owned with a mortgage
Rented
Other tenure type
Not specified
How many people live in your home? (including yourself)
1
2
3
4
Other (please specify):______________________________
How many bedrooms are in your home?
1
2
3
4
5
Other (please specify):______________________________
Would you consider yourself as 'safe' living in our local area?
Yes
No
Other (please specify):______________________________
€¢ What would you say is the biggest health issue affecting the community?
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