Name

First Name

Last Name

Do you identify as Aboriginal or Torres Strait Islander?

Yes

No

Are you from a Culturally or Linguistically Diverse background?

Yes

No

Are you currently a member of a professional association/s?

Yes

No

Have you worked professionally with young people before?

Yes

No

Do you have a suitable living environment to care for a young person?

Yes

No

Do you have a child/children living at home with you?

Yes

No

If you are married or in a de facto relationship, is your partner willing to be assessed to be an authorised carer and to support you in your role as a PTC?

Yes

No

Are you (and other members of your household over 18) willing to undertake a Criminal Record and Working with Children Check?

Yes

No