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Crucial Conversations Enrollment
Organisation*
What cohort are you apart of?*

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Your Personal Details
Date of Birth*
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Postal Address*
Street Address Address Line 2 City State Post Code
What size T-Shirt are you?*

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WEX Virtual Enrollment
Have you previously participated in WEX?**
- Yes
- No
(If Yes) – What year did you participate in WEX Canberra?*
(If No) – Would you be interested in being a part of WEX Canberra as a participant?*
- Yes
- No
Your school year in 2020**
- Year 10
- Year 11
- Year 12
- No longer at school
School Name:*
School contact person and their role:*
School contact phone:*
School contact email:*
Are you interested in having a career in the Australian Government?*
- Yes
- No
Are you comfortable with interacting, sharing stories, providing images and voicing your opinion about your WEX experience?*
- Yes
- No
(Refer to E-Learning Safety Guidelines for Mentors)
(if no) – What makes you uncomfortable?*
How did you come to know about the WEX Program?*
- WEX e-News
- Family
- Friend
- School/University
- Other
(please specify)*

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Do you have an understanding of data collection?*
- Yes
- No
- Somewhat
Do you have an understanding of data use?*
- Yes
- No
- Somewhat
Have you accessed the ABS Website for data?*
- Yes
- No
How often?*
- All the time.
- Sometimes.
- Rarely/a few times.
How confident are you in using ABS data?*
- Extremely.
- Somewhat.
- Not at all.
- N/A
How would you prefer data to be displayed?*
- Visually.
- Written.
- In tables.
- A combination of the above.
- Unsure.
- Do not use data.
Do you have internet stability?*
- Yes
- No
- Sometimes
Which of these statements best describes you?*
- I am a regular data user
- I have a strong interest in health
- I don't really use data, but I am interested in the health of my community

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