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First Name
Surname
Address
Post Code
Phone: Home
Phone: Work
Phone: Mobile
Email
Gender
FEMALE
MALE
AGE GROUP
1: <17
2a: 18-20
2b: 21-24
3: 25-34
4a: 35-44
4b: 45-49
5a: 50-54
5b: 55-64
6: 65 +
How did you hear about us
A: Previous Interview
B: Word of Mouth
C: Centrelink
D: Counsellor/Doctor/Therapist
E: Special Event
H: Go Volunteer
I: FNQ Volunteers Web Site
J: JSA Provider
M: Media/TV/Print/Radio/Walk in
P: Phone Book
Are you
local FNQ resident
An overseas traveller/visitor on holidays in FNQ
An Australian traveller/visitor on holidays in FNQ
Are you registered with a Job Services Provider
YES
NO
What is your primary reason for volunteering
A: Help others/Give back to the community
B: Personal Satisfaction
C: to be active/Keep busy
D: Using skills/Learning new skills
E: Gain work experience/References
F: Build confidence/Self-Esteem
G: Social interaction/Meet people
H: Make a difference
I: Centrelink/JSA provider
J: Practicing English
What kind of volunteer work would you like to do
What times are you available for volunteer work
Weekdays only
Weekends only
Both
Evenings only
Other times eg (school holidays only)
What locations or suburbs can you travel to
Cairns City Suburbs
Northern Beaches
Woree
Bentley Park
Edmonton
Gordonvale
Babinda
Innisfail
Mission Beach
Tully
Cardwell
Port Douglas
Mossman
Mareeba
Atherton
Other Tableland Towns
Please read the following statements
My interest in volunteering is based on personal choice and is undertaken freely.
I accept that FNQ Volunteers will use the above information for research,
statistical analysis & follow up purposes & may communicate with
organisations or case managers about details I have provided to negotiate any final decisions about my volunteering.
Once referred to an organisation, I understand that it is my responsibility
to communicate with that organisation and negotiate any final decision about volunteering.
I give my permission for FNQ Volunteers to contact me by email for the purpose as indicated above.
*
I have read the above statement
I AGREE
I DO NOT AGREE
*
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