White and Black Caribbean Other mixed background, please specify: C Asian or Asian British: Bangladeshi Indian Pakistani Other Asian background, please specify: D Black or Black British: African Caribbean Other Black British background, please specify: E Chinese or other ethnic group: Chinese Other, please specify: F Prefer not to say: These categories do not refer to the place of birth, citizenship or nationality, but to the ethnic group to which you belong. I hereby give my consent for the information contained in this form to be processed for monitoring purposes. Signature: Date:
White and Black Caribbean Other mixed background, please specify: C Asian or Asian British: Bangladeshi Indian Pakistani Other Asian background, please specify: D Black or Black British: African Caribbean Other Black British background, please specify: E Chinese or other ethnic group: Chinese Other, please specify: F Prefer not to say: These categories do not refer to the place of birth, citizenship or nationality, but to the ethnic group to which you belong. I hereby give my consent for the information contained in this form to be processed for monitoring purposes. Signature: Date: