VisionWorks™ Program Application
By applying to join the program you also give us permission to contact yourself and your parent/guardians regarding any matters relating to your participation in the VisionWorks™ program, for example any engagements or activities we plan around your Vision. Don't worry we promise we don't spam you or sell your details to anyone. We will use your email address to contact you. So please give us the details of the most current one that you check regularly.
Date
-
Day
-
Month
Year
Date
Hour Minutes
AM
PM
AM/PM Option
First name
*
Last name
*
Preferred name
*
This will be the name that will appear on your name tag
Which VisionWorks™ program are you applying for?
*
Please Select
Aveley SC
Joseph Banks SC
Bullsbrook C
Ocean Reef SH
Yanchep SC
Mt Lawley SHS
Wanneroo SC
Balcatta SHS
Individual Sessions
Night VisionWorks™
MLC Athens
MLC Corinth
MLC Olympia
MLC Rome
MLC Troy
MLC Sparta
Student e-mail
*
example@example.com
What is your mobile number
*
Have you previously applied for a VisionWorks™ Program
Please Select
Yes
No
What is your date of birth?
*
Please select a day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Day
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a year
2025
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Year
Gender
*
Please Select
Female
Male
Non-Binary
Prefer not to say
Current school year
*
Please Select
7
8
9
10
11
12
Are you of Aboriginal or Torres Strait Islander origin?
*
No
Yes, Aboriginal
Yes, Torres Strait Islander
Yes, BOTH Aboriginal & Torres Strait Islander
Parent/Guardian full name
*
First Name
Last Name
Parent/Guardian e-mail (All G if you don't know it - just leave blank)
example@example.com
Parent/Guardian phone number
*
How are they related to you?
*
Please Select
Mum
Dad
Step Mum
Step Dad
Grandparent
Guardian
Other
Now we have some more detailed questions...
Goal/Vision Orientated Thinking
I believe I have what it takes to shape my future.
*
Strongly Disagree
1
2
3
4
Strongly Agree
5
1 is Strongly Disagree, 5 is Strongly Agree
I have a clear idea of what I want to do in the future.
*
Strongly Disagree
1
2
3
4
Strongly Agree
5
1 is Strongly Disagree, 5 is Strongly Agree
I enjoy learning new skills that move me closer to my goals/vision.
*
Strongly Disagree
1
2
3
4
Strongly Agree
5
1 is Strongly Disagree, 5 is Strongly Agree
I feel capable of setting and working toward personal goals/vision.
*
Strongly Disagree
1
2
3
4
Strongly Agree
5
1 is Strongly Disagree, 5 is Strongly Agree
I believe I belong in my school and my community.
*
Strongly Disagree
1
2
3
4
Strongly Agree
5
1 is Strongly Disagree, 5 is Strongly Agree
Back
Next
Pathways Thinking
I know the steps I need to take to reach my goals/vision.
*
Strongly Disagree
1
2
3
4
Strongly Agree
5
1 is Strongly Disagree, 5 is Strongly Agree
I can think of many ways to achieve the goals/vision I care about.
*
Strongly Disagree
1
2
3
4
Strongly Agree
5
1 is Strongly Disagree, 5 is Strongly Agree
I can find another way when something doesn’t go as planned.
*
Strongly Disagree
1
2
3
4
Strongly Agree
5
1 is Strongly Disagree, 5 is Strongly Agree
I know how to break big goals/vision into smaller, doable steps.
*
Strongly Disagree
1
2
3
4
Strongly Agree
5
1 is Strongly Disagree, 5 is Strongly Agree
I can solve problems without giving up too quickly.
*
Strongly Disagree
1
2
3
4
Strongly Agree
5
1 is Strongly Disagree, 5 is Strongly Agree
Back
Next
Agency Thinking (Self Belief)
I feel confident in my ability to overcome challenges.
*
Strongly Disagree
1
2
3
4
Strongly Agree
5
1 is Strongly Disagree, 5 is Strongly Agree
I trust myself to keep going, even when things are hard.
*
Strongly Disagree
1
2
3
4
Strongly Agree
5
1 is Strongly Disagree, 5 is Strongly Agree
I believe I can make choices that lead to the life I want.
*
Strongly Disagree
1
2
3
4
Strongly Agree
5
1 is Strongly Disagree, 5 is Strongly Agree
I feel motivated to give my best in things that matter to me.
*
Strongly Disagree
1
2
3
4
Strongly Agree
5
1 is Strongly Disagree, 5 is Strongly Agree
I know how to ask for help when I need it.
*
Strongly Disagree
1
2
3
4
Strongly Agree
5
1 is Strongly Disagree, 5 is Strongly Agree
I want to make a positive difference in the world.
*
Strongly Disagree
1
2
3
4
Strongly Agree
5
1 is Strongly Disagree, 5 is Strongly Agree
I believe something good is ahead for me.
*
Strongly Disagree
1
2
3
4
Strongly Agree
5
1 is Strongly Disagree, 5 is Strongly Agree
I feel ready to learn new things to grow into my future self.
*
Strongly Disagree
1
2
3
4
Strongly Agree
5
1 is Strongly Disagree, 5 is Strongly Agree
I feel supported by people who believe in me.
*
Strongly Disagree
1
2
3
4
Strongly Agree
5
1 is Strongly Disagree, 5 is Strongly Agree
I feel connected to people who care about me.
*
Strongly Disagree
1
2
3
4
Strongly Agree
5
1 is Strongly Disagree, 5 is Strongly Agree
I understand my feelings and can manage them when needed.
*
Strongly Disagree
1
2
3
4
Strongly Agree
5
1 is Strongly Disagree, 5 is Strongly Agree
I believe I can achieve anything I want.
*
Strongly Disagree
1
2
3
4
5
6
Strongly Agree
7
1 is Strongly Disagree, 7 is Strongly Agree
I feel confident in what I can do.
*
Strongly Disagree
1
2
3
4
5
6
Strongly Agree
7
1 is Strongly Disagree, 7 is Strongly Agree
I know how to set and work toward goals.
*
Strongly Disagree
1
2
3
4
5
6
Strongly Agree
7
1 is Strongly Disagree, 7 is Strongly Agree
I can handle challenges well.
*
Strongly Disagree
1
2
3
4
5
6
Strongly Agree
7
1 is Strongly Disagree, 7 is Strongly Agree
I understand how my choices impact my future.
*
Strongly Disagree
1
2
3
4
5
6
Strongly Agree
7
1 is Strongly Disagree, 7 is Strongly Agree
I put effort into my schoolwork.
*
Strongly Disagree
1
2
3
4
5
6
Strongly Agree
7
1 is Strongly Disagree, 7 is Strongly Agree
I stay organised and manage my time well.
*
Strongly Disagree
1
2
3
4
5
6
Strongly Agree
7
1 is Strongly Disagree, 7 is Strongly Agree
I enjoy learning new skills or topics.
*
Strongly Disagree
1
2
3
4
5
6
Strongly Agree
7
1 is Strongly Disagree, 7 is Strongly Agree
I take part in class discussions and group projects.
*
Strongly Disagree
1
2
3
4
5
6
Strongly Agree
7
1 is Strongly Disagree, 7 is Strongly Agree
I understand my feelings and can manage them.
*
Strongly Disagree
1
2
3
4
5
6
Strongly Agree
7
1 is Strongly Disagree, 7 is Strongly Agree
I feel connected to people around me.
*
Strongly Disagree
1
2
3
4
5
6
Strongly Agree
7
1 is Strongly Disagree, 7 is Strongly Agree
I am good at listening and talking with others.
*
Strongly Disagree
1
2
3
4
5
6
Strongly Agree
7
1 is Strongly Disagree, 7 is Strongly Agree
I feel supported by people in my life.
*
Strongly Disagree
1
2
3
4
5
6
Strongly Agree
7
1 is Strongly Disagree, 7 is Strongly Agree
I feel like I belong to my school and my community.
*
Strongly Disagree
1
2
3
4
5
6
Strongly Agree
7
1 is Strongly Disagree, 7 is Strongly Agree
I have a clear idea of what I want to do in the future.
*
Strongly Disagree
1
2
3
4
5
6
Strongly Agree
7
1 is Strongly Disagree, 7 is Strongly Agree
I know the steps to reach my goals.
*
Strongly Disagree
1
2
3
4
5
6
Strongly Agree
7
1 is Strongly Disagree, 7 is Strongly Agree
I feel ready to learn new skills for the future.
*
Strongly Disagree
1
2
3
4
5
6
Strongly Agree
7
1 is Strongly Disagree, 7 is Strongly Agree
I see how I can give back to my community
*
Strongly Disagree
1
2
3
4
5
6
Strongly Agree
7
1 is Strongly Disagree, 7 is Strongly Agree
I know how to work with people who have different personalities
*
Strongly Disagree
1
2
3
4
5
6
Strongly Agree
7
1 is Strongly Disagree, 7 is Strongly Agree
I want to make a positive difference in the world
*
Strongly Disagree
1
2
3
4
5
6
Strongly Agree
7
1 is Strongly Disagree, 7 is Strongly Agree
Back
Next
Last But Not Least
How do you find asking for help?
*
Very Difficult
1
2
3
4
5
6
Very Easy
7
1 is Very Difficult, 7 is Very Easy
How clear is YOUR vision for the future?
*
Very Unclear
1
2
3
4
5
6
Very Clear
7
1 is Very Unclear, 7 is Very Clear
What's your dream?
*
What do you feel challenges you the MOST? Tick all that apply.
*
Being told What To Do
FOMO (Fear of Missing Out)
Fear Of The Unknown
Lack of Support From Others
Sadness
Struggling To Focus or Concentrate
Thinking I am Not Good Enough
Applying For A Job/Apprenticeship
Applying for Work Experience
Writing Resumes/Job Applications
Asking Teachers & Career Advisor For Help
What To Do When I Feel Undervalued
What To Do When I Feel Nervous
What To Do If I am Struggling At School/Work
What To Do If I Face Unfair Treatment
Budgeting & Saving Money
Social Media & Online Safety
Setting Boundaries
Consent Measures
Equity & Discrimination
The things that challenge you might be the opportunities to improve and move towards your goals.
Do you have the necessary skills and knowledge to achieve your future vision?
*
No, none at all
1
2
3
4
5
6
Yes, Many
7
1 is No, none at all, 7 is Yes, Many
What are some things you definitely do NOT want in your future?
*
What’s is the soundtrack of your life/music that best represents You?
*
Favourite Song/Artist/Album/Genre etc
Do you want to participate in this program?
*
Yes, I want to start immediately
Yes, I would like to join in the future
No
What excites you about our program?
*
What Is currently working in your life?
*
What is currently NOT working in your life?
*
Which of the following do you need support in? Tick all that apply.
*
Social - Connecting With Others
Educational - Passing School
Vocational - Getting a Job
Emotional - Mental Health & Wellbeing
Have you ever received mental health support from a counsellor, healthcare professional or an online resource?
Please Select
Yes, previously
Yes, currently
No, never
I prefer not to say
What stops you from doing your best? (Tick all that apply)
*
I Need To Be Perfect
I Procrastinate A Lot
I Do a Lot Of Negative Self-Talk
I Give Up Easily
I Struggle To Get Along With People
Other
Example - Giving up when it all gets "too hard"
What kind of person would you like people to describe you as?
*
What do you think is missing in helping young people achieve a positive based future?
*
What would you like to get out of this program
*
So that we can recognize you take/add a selfie. This is for our use only. We will not share your picture with anyone.
What challenges do you currently face at school or in life?
*
What is one thing you hope to learn or improve about yourself in this program?
*
How do you see yourself contributing to your school and community?
*
Submit
Should be Empty: