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SWAN Planning

About You

1. What is your relationship with SWAN *This question is required.

2. Who primarily receives the service or information? *This question is required.

Yourself
Family member
Other significant person
Other - Write In

3. Your Gender *This question is required.

Please enter an 'other' value for this selection.

4. Your age. *This question is required.

7. How many family or 'significant others' who receive these services are aged between the following years?

0-2
3-10
11-17
18-24
25-34
35-44
45-54
55-64
65-74
74 or older

8. How many family or 'significant others' identify in one of the following gender categories?

Male
Female
Transgender Male
Transgender Female
Gender Variant/Non-Conforming
Other
Prefer not to answer

9. How many family or 'significant others' identify as Aboriginal or Torres Straight Islander?

Aboriginal or Torres Straight Islander
Prefer not to answer

10. Do you represent? *This question is required.

Please enter an 'other' value for this selection.

11. What is your relationship with SWAN? *This question is required.

Please enter an 'other' value for this selection.

12. How best would you describe the relationship between the organisation and SWAN? *This question is required.

Please enter an 'other' value for this selection.

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