UNIVERSITY OF SYDNEY and the NSW LAW REFORM COMMISSION
MAGISTRATES COURT STUDY
THANK YOU FOR AGREEING TO FILL OUT THIS FORM.
We want to find out about the educational background of people who come before Magistrates Courts. The NSW Law Reform Commission and the University of Sydney are collecting the information. The results will help the Law Reform Commission to understand the difficulties people face when they go to court. Then the Commission can decide if things need to be changed, to make the court process better. That will help everyone. There is another way you can be helped. If this form shows anything that needs to be followed up by your solicitor, that information will be passed on to your solicitor.
PLEASE FILL IN ALL THE ANSWERS TO THE QUESTIONS BELOW. IF YOU HAVE ANY PROBLEMS, ASK FOR HELP FROM THE PERSON WHO GAVE YOU THE FORM.
Surname ___________________________
Other Names________________________
Date of Birth ___/___/___ Age________
Are you (please tick) Male____ Female___
Are you (please tick)
Aboriginal, Koori ___
Islander ___
None of these ___
Were you born in Australia? Yes ___ No ___
If no, where were you born?
___
What grade were you in when you left school?
___________________________________
What was the last school you went to?
___________________________________
How many different schools did you go to?
(write in number)______________________
Were you ever in a special class or school?
If yes, what was the name of the school? (write in)
___________________________________
Were you ever in an OA or OF class?
No _____
OA _____
OF _____
Are you in paid work, or unemployed?
Working _____ Unemployed _____
If you are in paid work, what work do you do?
___________________________________
___________________________________
Full-time or Part-time paid work?
Do you get a pension or benefit?
If yes, tick what type
If you do not receive a pension now, have you ever been on a pension or benefit in the past? Yes _____ No _____
Which pension?
Unemployment___
Job Search___
Sickness ___
War/Veterans___
Disability Support (Invalid Pension)___ Other (write in) ___________________________________
Are you at court today because you are charged with an offence?
Yes ____ No ____
Are you charged with more than one offence?
Yes _____ No _____
How many? (write in number) ___________
What is the most serious charge? (please write in)
___________________________________
___________________________________
What are the other charges?
___________________________________
___________________________________
___________________________________
___________________________________
Are you at court for any other reason today? (please write in)
___________________________________
Have you ever been charged with an offence before? Yes _____ No _____
How many offences have you been charged with in the past? Please write in -
___________________________________
What offences were they?
___________________________________
___________________________________
___________________________________
___________________________________
Do you have a lawyer? (please tick)
No _____
Legal Aid _____
Private Solicitor _____
Please write in the name and telephone number of your solicitor, if you wish to.
Name:___________________________________
Telephone Number:_________________________
Were you drinking alcohol on the day of the alleged offence?
How much alcohol did you have that day?
___________________________________
Were you intoxicated at that time?
What effect did the alcohol have on you?
___________________________________
___________________________________
Did you have any other drugs on the day of the alleged offence?
Please write in what drugs you had -
___________________________________
___________________________________
___________________________________
Were you affected by the drug(s) on that day?
How were you affected?
___________________________________
FOR OFFICE USE ONLY
COURT - ___________________________________
DATE - _____________________________________
ORIENTATION (Year, season, month, date, day - Record) [5]
LOCATION (State, suburb, street, place, floor - Record) [5]
REGISTRATION (3 objects - repeat all three - repeat until learned -Record correct no. and no. of repetitions) [3]
SERIAL SEVENS (1 point for each correct, to max. 5) [5]
BACKWARDS WORLD (record no. of letters correct) [5]]
THREE STAGE COMMAND (Paper right, fold, lap) [3]
TOTAL OUT OF 26_____
INTERVIEWER’S NOTES
For all items, record as follows: 1= Serious 2= Mild 3= Slight 4= Not present 5 = Don’t Know
ID______
NESB______
MI______
D/A_____
OTHER OBSERVATIONS
___________________________________
___________________________________
___________________________________
___________________________________
RAW SCORE ON MATRICES
STANDARD SCORE ON MATRICES
PERCENTILE RANK
CATEGORY
