If you would prefer to not supply any of the following information, please tick here. Gender Male Female Prefer not to say Age 66 and over 56 - 65 46 55 36 - 45 26 35 – – 25 and under Prefer not to say Ethnic Asian or Asian British Origin Bangladeshi Indian Pakistani Chinese Other Specify if you wish ________________________________ Black or Black British African Caribbean Other Specify if you wish ________________________________ Asian and White Black African and White Black Caribbean and White Other Specify if you wish ________________________________________ White White Other Specify if you wish ________________________________ Any other background Specify if you wish _________________________________________ Prefer not to say Religion None Christian (inc. all denominations) Buddhist Hindu Jewish and Belief Muslim Sikh Other Specify if you wish ________________________________ Disability Do you consider yourself to be a disabled person? Yes No Prefer not to say Sexual Gay Lesbian Bisexual Heterosexual Orientation Other Specify if you wish ________________________________ Prefer not to say
If you would prefer to not supply any of the following information, please tick here. Gender Male Female Prefer not to say Age 66 and over 56 - 65 46 – 55 36 - 45 26 – 35 25 and under Prefer not to say Ethnic Origin Asian or Asian British Bangladeshi Indian Pakistani Chinese Other Specify if you wish ________________________________ Black or Black British African Caribbean Other Specify if you wish ________________________________ Asian and White Black African and White Black Caribbean and White Other Specify if you wish ________________________________________ White White Other Specify if you wish ________________________________ Any other background Specify if you wish _________________________________________ Prefer not to say Religion and Belief None Christian (inc. all denominations) Buddhist Hindu Jewish Muslim Sikh Other Specify if you wish ________________________________ Disability Do you consider yourself to be a disabled person? Yes No Prefer not to say Sexual Orientation Gay Lesbian Bisexual Heterosexual Other Specify if you wish ________________________________ Prefer not to say