Q13 Which age group do you fall into? 18 18 - 24 25 - 34 35 - 44 45 - 54 55 - 64 65 - 74 75 or over Prefer not to say Q14 Disability The definition of disability in the Equality Act is: physical or mental impairment affecting ‘a the body or mind which has a substantial or long term adverse effect on the ability to carry out normal day-to-day activities’. Do you consider yourself to be disabled? Yes No Prefer not to say Q15 How would you describe your nationality Ethnic Group (You may tick more than one) White Welsh White English White Scottish White Northern Irish White British White Other Asian Indian – Asian Pakistani – Bangladeshi – Asian Chines – Other – Black- African Black Caribean – Black - Other Arabic Other Prefer not to say Q16 What is your religious status No religion
Q13 Which age group do you fall into? 18 18 - 24 25 - 34 35 - 44 45 - 54 55 - 64 65 - 74 75 or over Prefer not to say Q14 Disability The definition of disability in the Equality Act is: ‘a physical or mental impairment affecting the body or mind which has a substantial or long term adverse effect on the ability to carry out normal day-to-day activities’. Do you consider yourself to be disabled? Yes No Prefer not to say Q15 How would you describe your nationality Ethnic Group (You may tick more than one) White Welsh White English White Scottish White Northern Irish White British White Other Asian – Indian Asian – Pakistani – Bangladeshi Asian – Chines – Other Black- African Black – Caribean Black - Other Arabic Other Prefer not to say Q16 What is your religious status No religion