Nationality Married / civil partnered Single ◻ ◻ Marital status Divorced Legally separated ◻ ◻ Widowed ◻ Buddhist Christian ◻ ◻ Religion or belief Hindu Jewish ◻ ◻ Muslim Sikh ◻ ◻ Some other religion or belief No religious belief ◻ ◻ Ethnic origin A White (Census 2011 Ethnicity Categories) English/Welsh/Scottish/Northern Irish/British ◻ Irish ◻ Gypsy or Irish Traveller ◻ Other White Background (write in) ◻ B Mixed/multiple ethnic groups White and Black Caribbean ◻ White and Black African ◻ White and Asian ◻ Any other mixed/multiple ethnic background (write in) ◻ C Asian/Asian British Indian ◻ Pakistani ◻ Bangladeshi ◻ Chinese ◻ Any other Asian background (write in) ◻ D Black/African/Caribbean/Black British African ◻ Pakistani ◻ Caribbean ◻ Any other Black/African/Caribbean background (write in) ◻ E Other ethnic group Arab ◻ Any other Black/African/Caribbean background (write in) ◻
Nationality Marital status ◻ Married / civil partnered ◻ Single ◻ Divorced ◻ Legally separated ◻ Widowed Religion or belief ◻ Buddhist ◻ Hindu ◻ Muslim ◻ Some other religion or belief ◻ Christian ◻ Jewish ◻ Sikh ◻ No religious belief Ethnic origin (Census 2011 Ethnicity Categories) A White ◻ English/Welsh/Scottish/Northern Irish/British ◻ Irish ◻ Gypsy or Irish Traveller ◻ Other White Background (write in) B Mixed/multiple ethnic groups ◻ White and Black Caribbean ◻ White and Black African ◻ White and Asian ◻ Any other mixed/multiple ethnic background (write in) C Asian/Asian British ◻ Indian ◻ Pakistani ◻ Bangladeshi ◻ Chinese ◻ Any other Asian background (write in) D Black/African/Caribbean/Black British ◻ African ◻ Pakistani ◻ Caribbean ◻ Any other Black/African/Caribbean background (write in) E Other ethnic group ◻ Arab ◻ Any other Black/African/Caribbean background (write in)
home-help-application-form-v4-with-gdpr-1.docx