Action Step form (test) (Copy) Breadcrumb Home Action Step Form (test) (Copy) First Name Last Name Address Suburb Postcode Phone Number Email Address Is it safe to phone, text and email? (Please select) No Yes If not, how can we safely make contact? How did you hear about us? (Please select) Aboriginal Legal Service Community Worker/Organisation Education Provider Fair Trading Health Service Law Access/Legal Aid Other Details of your matter What questions do you have? Are there any deadlines in your matter? Date of Birth Gender Please select Male Female Intersex or indeterminate Other Transgender Unknown (Not Stated) X not male or female Preferred Pronouns She/Her He/Him They/Them Other (Please select) Country of Birth Aboriginal and Torres Strait Islander Status Please Select No Yes, Aboriginal Yes, Torres Strait Islander Both Aboriginal and Torres Strait Islander Unknown (Not stated / inadequately described) Are you an International Student? (Please select) Yes No Education Provider Please select Australian Catholic University Charles Sturt University Macquarie University Newcastle University Notre Dame Sydney University Southern Cross University TAFE Torrens University University of New England UNE University of NSW UNSW University of Technology UTS University of Western Sydney UWS University of Wollongong Other Disability Status No Head injury, stroke or brain injury Intellectual Physical Psychological Sensory/Speech Other Unknown Centrelink Status Please select ABSTUDY Age Pension Austudy Carer Payment Disability Support Pension Family Tax Benefit Jobkeeper Jobseeker Newstart Allowance Parenting Payment Veterans benefit Youth Allowance Other No Unknown Employment Status Please select Employed Unemployed Unknown Other Income Level Please select Nil income $1-199 weekly ($1-$10,399 yearly) $200 - $299 weekly ($10,400 - $15,599 yearly) $300 - $399 weekly ($15,600-$20,799 yearly) $400 - $599 weekly ($20,800-$31,199 yearly) $600 - $799 weekly ($31,200 - $41,599 yearly) $800 - $999 weekly ($41,600-$51,999 yearly) $1000 - $1249 weekly ($52,000-$64,999 yearly) $1250 - $1499 weekly ($65,000-$77,999 yearly) $1500 - $1999 weekly ($78,000-$103,999 yearly) $2000 or more weekly ($104,000 or more yearly) Is an interpreter needed? (Please select) No Yes What language? RLC Admin Only