People Bank: tell us about you

Thank you for registering to be a part of the Jean Hailes People Bank.

Your personal information will be handled in accordance with the Jean Hailes privacy policy.

You can opt out from receiving communications related to People Bank at any time.

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* Your contact details

Name *

Email *

Phone number

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* State

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* Which type of location best describes where you live?

Metropolitan

Regional

Rural or remote

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* How do you describe your gender?

Female

Male

Prefer not to answer

I use another term (please specify)

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* In what year were you born? (enter 4-digit birth year; for example, 1976)

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* In what country were you born?

Australia

Other (please specify)

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* Do you speak a language other than English at home?

No, I only speak English at home

Yes, I speak another language at home (please specify)

Prefer not to answer

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* Are you of Aboriginal or Torres Strait Islander origin?

Yes

Prefer not to answer

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* Do you have a disability (physical, mental, sensory or other types of disability)?

Yes

Prefer not to answer

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* Do you identify as LGBTIQA+?

Yes

Prefer not to answer

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* What is the highest level of education you completed?

Primary school

Secondary school

Tertiary education (TAFE, university)

Prefer not to answer

People Bank: tell us about you

Thank you for registering to be a part of the Jean Hailes People Bank.

Question Title

* Your contact details

Question Title

* State

Question Title

* Which type of location best describes where you live?

Question Title

* How do you describe your gender?

Question Title

* In what year were you born? (enter 4-digit birth year; for example, 1976)

Question Title

* In what country were you born?

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* Do you speak a language other than English at home?

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* Are you of Aboriginal or Torres Strait Islander origin?

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* Do you have a disability (physical, mental, sensory or other types of disability)?

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* Do you identify as LGBTIQA+?

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* What is the highest level of education you completed?

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* Where did you hear about Jean Hailes People Bank?