☐ Bisexual ☐ Two-spirit [Show list to respondent. Check all that apply] ☐ Queer ☐ Questioning (PiT Q12) ☐ Not listed: _______ ☐ Don’t Know ☐ Decline to answer ☐ English In what language do you feel best able to ☐ French express yourself? ☐ No preference ☐ Neither (please specify)______ (C09) ☐ Don’t Know ☐ Decline to answer ☐ Yes, Military Have you ever had any service in the ☐ Yes, RCMP Canadian military or RCMP? (Military includes ☐ No Canadian Navy, Army or Air Force) ☐ Don’t Know ☐ Decline to answer (PiT Q10) Do you identify as having any of the following? (Ontario specific question) Medical Physical Disability Addiction Mental Health Issue Condition ☐ Yes ☐ Yes ☐ Yes ☐ Yes ☐ No ☐ No ☐ No ☐ No ☐ Don’t Know ☐ Don’t Know ☐ Don’t Know ☐ Don’t Know ☐ ☐ ☐ Decline to answer Decline to answer Decline to answer ☐ Decline to answer ☐ Yes Length (in ________ Have you ever been in foster care and/or a ☐ No group home? ☐ Don’t Know ☐ Decline to answer If yes, how long ago was that? (C02) ☐ Employment What are your sources of income? ☐ Informal / Self-Employment (e.g., bottle returns, [Read list and select all that apply] panhandling)
[Show list to respondent. Check all that apply] (PiT Q12) ☐ Bisexual ☐ Two-spirit ☐ Queer ☐ Questioning ☐ Not listed: _______ ☐ Don’t Know ☐ Decline to answer In what language do you feel best able to express yourself? (C09) ☐ English ☐ French ☐ No preference ☐ Neither (please specify)______ ☐ Don’t Know ☐ Decline to answer Have you ever had any service in the Canadian military or RCMP? (Military includes Canadian Navy, Army or Air Force) (PiT Q10) ☐ Yes, Military ☐ Yes, RCMP ☐ No ☐ Don’t Know ☐ Decline to answer Do you identify as having any of the following? (Ontario specific question) Medical Condition ☐ Yes ☐ No ☐ Don’t Know ☐ Decline to answer Physical Disability ☐ Yes ☐ No ☐ Don’t Know ☐ Decline to answer Addiction ☐ Yes ☐ No ☐ Don’t Know ☐ Decline to answer Mental Health Issue ☐ Yes ☐ No ☐ Don’t Know ☐ Decline to answer Have you ever been in foster care and/or a group home? If yes, how long ago was that? (C02) ☐ Yes Length (in ________ ☐ No ☐ Don’t Know ☐ Decline to answer What are your sources of income? [Read list and select all that apply] ☐ Employment ☐ Informal / Self-Employment (e.g., bottle returns, panhandling)
VI-SPDAT-20K-RW-ONTARIO-ONLY-1.docx