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THE NEIGHBOURHOOD CENTRE
Volunteer Engagement and Management Program
FEEDBACK FORM - Board
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2
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1
2
Initials:
First
Last
Year of Birth:
DD
/
MM
/
YYYY
Country of Birth:
Aboriginal/Torres Strait Islander:
Yes
No
Main Language spoken at home:
Disability - additional information:
Intellectual learning
Psychiatric
Sensory / Speech
Physical / Diverse
Not Stated
None
I give my consent to allow The Neighbourhood Centre to report this information to the Department of Social Services as a requirement of their funding agreement.
Yes
No
Postcode:
1
/
2
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