General Information

Please note that this information is confidential. It is useful for us to understand who our students are when we are planning the classes. We need to include some of this information in reports to the funders of the project. Responses will be grouped for statistical purposes so individual responses cannot be identified. Results are reported on the basis of these grouped results only, which means that your responses and participation are anonymous.

* Instructions
When a question has an asterix* next to it then an answer is required to this question. You need to answer it before you can move on to the next page of the survey. This is information we need to register you for the classes.

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* 1. Please give today's date, for example 20/10/2007.

Date

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* 2. CTC or training centre name

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* 3. Your region? Please tick the region where you are will attend Stepping Up classes from the list below. You may tick one region only.

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* 4. What is your first name:

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* 5. What is your last name?

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* 6. Address:

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* 7. Phone number:

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* 8. Email:

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