Federation of Indian Communities of Queensland(FICQ) like to know the demographics of the elderly Indians living in Queensland, so that we can help you.
 
The data collected will not be utilised beyond the current crisis without permission of the respondent and will be stored securely.

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* 1. Full Name

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* 2. Gender

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* 3. How old are you?

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* 4. Citizenship Status:

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* 5. Have you travelled to or from  Australia in past 2-3 weeks?

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* 6. What's your living status?

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* 7. How can FICQ support you , if you anticipate that coronavirus might impact you ?

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* 8. what suburb of Queensland you reside in ?(to be used only for support purpose)

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* 9. Contact Number (if you want the organisation to contact you).Enter : +61.........

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