[Dace]

PERSONAL DETAILS

Please enter your study personal reference number here: []
Please enter your post code here: []
Please enter your age here: []


FAMILY


HOME

Please mark the following boxes to best reflect the make up of your family home

Father []
Mother []
Step-father (married) []
Step-mother (married) []
Biological Father's partner []
Biological Mother's partner []
Elder brother (please enter number of elder brothers in box and age difference to you in the brackets) [] ()
Elder sister (please enter number of elder sisters in box and age difference to you in the brackets) [] ()
Younger brother (please enter number of younger brothers in box and age difference to you in the brackets) [] ()
Younger sister (please enter number of younger sisters in box and age difference to you in the brackets) [] ()
Father's Father []
Father's Mother []
Mother's Father []
Mother's Mother []
Other []

FAMILY CONTACT

Please mark down how regularly you have contact (in days) with:

Father []
Mother []
Step-father (married) []
Step-mother (married) []
Biological Father's partner []
Biological Mother's partner []
Elder brother (please enter number of elder brothers in box and age difference to you in the brackets) [] ()
Elder sister (please enter number of elder sisters in box and age difference to you in the brackets) [] ()
Younger brother (please enter number of younger brothers in box and age difference to you in the brackets) [] ()
Younger sister (please enter number of younger sisters in box and age difference to you in the brackets) [] ()
Father's Father []
Father's Mother []
Mother's Father []
Mother's Mother []
Other []

FAMILY LOCATION

Please mark down how far (in miles) the following members of your family live from you

Father []
Mother []
Step-father (married) []
Step-mother (married) []
Biological Father's partner []
Biological Mother's partner []
Elder brother (please enter number of elder brothers in box and age difference to you in the brackets) [] ()
Elder sister (please enter number of elder sisters in box and age difference to you in the brackets) [] ()
Younger brother (please enter number of younger brothers in box and age difference to you in the brackets) [] ()
Younger sister (please enter number of younger sisters in box and age difference to you in the brackets) [] ()
Father's Father []
Father's Mother []
Mother's Father []
Mother's Mother []
Other []



EDUCATION


Please enter the code of any school you attended
[ENTER SCHOOL CODE]
Have you been suspended at any time? If so how many times (please enter figure in the following box) []
have you been expelled at any time? If so please tick the following box []
[ENTER SCHOOL CODE]
Have you been suspended at any time? If so how many times (please enter figure in the following box) []
have you been expelled at any time? If so please tick the following box []
[ENTER SCHOOL CODE]
Have you been suspended at any time? If so how many times (please enter figure in the following box) []
have you been expelled at any time? If so please tick the following box []
[ENTER SCHOOL CODE]
Have you been suspended at any time? If so how many times (please enter figure in the following box) []
have you been expelled at any time? If so please tick the following box []
[ENTER SCHOOL CODE]
Have you been suspended at any time? If so how many times (please enter figure in the following box) []
have you been expelled at any time? If so please tick the following box []


RELIGION

Do you regularly attend a religious ceremony?
YES [] NO []

If YES please mark how often:
Once a day []
Once a week []
Once a month []
Two - Three times a year []
Once a year []

If YES do you attend the religious ceremonies with any of the following:

Father []
Mother []
Step-father (married) []
Step-mother (married) []
Biological Father's partner []
Biological Mother's partner []
Elder brother (please enter number of elder brothers in box and age difference to you in the brackets) [] ()
Elder sister (please enter number of elder sisters in box and age difference to you in the brackets) [] ()
Younger brother (please enter number of younger brothers in box and age difference to you in the brackets) [] ()
Younger sister (please enter number of younger sisters in box and age difference to you in the brackets) [] ()
Father's Father []
Father's Mother []
Mother's Father []
Mother's Mother []
Other []







Note 1:
For family make-up i couldn't be bothered going through all possibly combinations of Aunts, Uncles, Cousins, Nephews and Nieces but they would be there.

Note 2:
For education there would be a seperate alphabetisised list of all the schools in the country wil a relevent code beside them