Data Collection Form This information is collected to enable the nationally comparable reporting of students’ outcome against the National Goals for Schooling in the 21st Century. The information is collected in accordance with Immaculate Heart College’s Privacy Policy. Please note: If you require assistance with this form please contact the College Reception on 9571 8135 or reception@ihc.wa.edu.auStudent Name(Required) First Last Date of Birth(Required) Home Address of Student(Required) Street Address City State / Province / Region ZIP / Postal Code AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzechiaDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussian FederationRwandaSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTürkiyeTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country 1. Gender(Required) Male Female 2. Is the student of Aboriginal or Torres Strait Islander origin?(Required) No ⁴ Yes, Aboriginal ¹ Yes, Torres Strait Islander ² Yes, both Aboriginal and Torres Strait Islander ³ 3. In which country was the student born?(Required) Australia New Zealand Other 4. In which country was the parent/carer 1 born?(Required) Australia New Zealand Other 5. In which country was the parent/carer 2 born?(Required) Australia New Zealand Other Please note: Where a student is born in Australia, but both parents are born overseas, please provide proof of residency and/or Australian citizenship.6. Does the student or either of their parent/carer speak a language other than English at home? (if more than one language, please indicate the one that is spoken most often)(Required) No, English only Yes, other - please specify for student, parent/carer 1 and parent/carer 2 if applicable 7 (a). What is the highest year of primary/secondary schooling the parents/carers have completed?Parent / Carer 1(Required) Year 12 or equivalent ⁴ Year 11 or equivalent ³ Year 10 or equivalent ² Year 9 or equivalent (or below) ¹ Parent / Carer 2 Year 12 or equivalent ⁴ Year 11 or equivalent ³ Year 10 or equivalent ² Year 9 or equivalent (or below) ¹ 7 (b). What is the level of the highest qualification on the parents/carers have completed?Parent / Carer 1(Required) Bachelor degree or above ⁷ Advanced Diploma/Diploma ⁶ Certificate I to IV (inc Trade Certificate) ⁵ No non-school qualification ⁸ Parent / Carer 2 Bachelor degree or above ⁷ Advanced Diploma/Diploma ⁶ Certificate I to IV (inc Trade Certificate) ⁵ No non-school qualification ⁸ 8 (a). What is the occupation group of the parent/carer 1?Please select the appropriate parental occupation and group from the list belowOccupationOccupational Group:(Required)Select one123488 (b). What is the occupation group of the parent/carer 2?Please select the appropriate parental occupation and group from the list belowOccupationOccupational Group:Select one12348 DECLARATIONI hereby declare that the information given in this document is complete, true and correct to the best of my knowledge and belief.Parent / Carer 1 Name Signature(Required) First Last Date(Required) Parent / Carer 2 Name Signature First Last Date
