Due to recent events concerning overseas Indian students, the Chinese Australian Forum is interested to find out the experience of Chinese students in Australia, whether they have experienced similar attacks. If you had been a victim of violence and you would like to share it with us, please complete the following questionnaire. All responses will be strictly confidential.

The CAF is a non-party political community based organisation. Details of the objectives of CAF can be found in the CAF website: http://www.caf.org.au/aboutus

因為近日不斷有關印度留學生受到暴力的報導，澳華論壇有興趣瞭解中國學生在澳洲所遭到的經驗。假如你曾經因種族原因而受到暴力對待，請填以下的問卷。你的個人資料，絕對保密。

澳華論壇為一個非政黨的社團組織，關於論壇的宗旨和活動，請查網址：http://www.caf.org.au/aboutus

1. Your name

性名

性別

2. Where do you study?

學習機構

大學

科技及再陪訓學院

語言學院

其他機構

3. How long have you been in Australia?

居澳時間

不到一年

years

年

澳洲出生

4. When did you experience a racially based violence against you?

你遭受到暴力的時間

日

Year

年

5. Was the violence

你所受的暴力襲擊類別

Date

身體攻擊

語言攻擊

心理攻擊

6. What was the outcome?

襲擊後果

Did it involve

有無下列人士介入

Your sex

Your age

年齡

其他 （請指明）

醫生

警察

心理輔導家

7. Would you like CAF to contact you?

你是否願意澳華論壇跟你聯繫

If you do, please give us the means you prefer to be contacted

如過願意的話。你的聯繫方法：

電話

手機

Telephone

Mobile

郵電

Email

地址

Address

Thank you for your help. Your identity will be kept strictly confidential. Your response would assist CAF in its anti-racism projects.

謝謝合作。你的個人資料絕對保密。你的經驗會有助於澳華論壇的反歧視活動。

Comments:

Anti-Racism Questionnaire