Ethnicity Asian or Asian British White Bangladeshi White British Indian White Irish Pakistani Any Other White Background Any Other Asian Background Ethnic Group Black or Black British Chinese African Any Other Ethnic Group Caribbean Please state: _____________________________ Any Other Black Background Rather not say Mixed White and Asian White and Black African White and Black Caribbean Any Other Mixed Background Nationality Please state: _______________________________ Gender 5b. Gender Reassignment Female Do you now, or have you ever considered yourself to be Male transgender? (tick if yes) Rather not say Religion or Beliefs Atheism Jainism Agnosticism Judaism Buddhism Sikhism Christianity Any Other Religion/Belief Hinduism Please state: ____________________________ Humanism No Religion or Belief Islam Rather not say Sexual Orientation Bisexual Lesbian/Gay Woman Gay Man Other Heterosexual Rather not say Are you currently providing support to a partner, child, relative, friend or neighbour who could not manage without your help or/and support? Yes No Rather not say We are asking you to provide us with anonymous information to help reach as many communities as we can. All questions are optional and if you prefer not to it does not in any way effect your access to services. Thank you.
Ethnicity Asian or Asian British Bangladeshi Indian Pakistani Any Other Asian Background Black or Black British African Caribbean Any Other Black Background Mixed White and Asian White and Black African White and Black Caribbean Any Other Mixed Background White White British White Irish Any Other White Background Ethnic Group Chinese Any Other Ethnic Group Please state: _____________________________ Rather not say Nationality Please state: _______________________________ Gender Female Male Rather not say 5b. Gender Reassignment Do you now, or have you ever considered yourself to be transgender? (tick if yes) Religion or Beliefs Atheism Agnosticism Buddhism Christianity Hinduism Humanism Islam Jainism Judaism Sikhism Any Other Religion/Belief Please state: ____________________________ No Religion or Belief Rather not say Sexual Orientation Bisexual Gay Man Heterosexual Lesbian/Gay Woman Other Rather not say Are you currently providing support to a partner, child, relative, friend or neighbour who could not manage without your help or/and support? Yes No Rather not say We are asking you to provide us with anonymous information to help reach as many communities as we can. All questions are optional and if you prefer not to it does not in any way effect your access to services. Thank you.