Do you identify as transgender/transsexual? Yes No Prefer not to say How would you describe your nationality and/or ethnicity (please tick)? A B C White: Mixed race: Asian or Asian British: British - English, White and Black Indian Scottish or Caribbean Welsh Irish White and Black Pakistani African Other White White and Asian Bangladeshi background Other Mixed Other Asian background background D E Black or Black Chinese and British: other groups: Chinese Prefer not to say African Other ethnic group Other Black background What is your age (please tick)? 16-20 21-30 31-40 41-50 □ □ □ □ □ 51-60 61-65 66-70 71+ Prefer □ □ □ □ not to say
Do you identify as transgender/transsexual? Yes No Prefer not to say How would you describe your nationality and/or ethnicity (please tick)? A White: B Mixed race: C Asian or Asian British: British - English, Scottish or Welsh White and Black Caribbean Indian Irish White and Black African Pakistani Other White background White and Asian Bangladeshi Other Mixed background Other Asian background D Black or Black British: E Chinese and other groups: Chinese Prefer not to say African Other ethnic group Other Black background What is your age (please tick)? 16-20 □ 21-30 □ 31-40 □ 41-50 □ 51-60 □ 61-65 □ 66-70 □ 71+ □ Prefer not to say □
Pipeland%20Practice%20Application%20Pack%20Oct%202016.docx