What is your sexual □ □ orientation? Please Heterosexual Gay tick the appropriate box: Lesbian Bisexual □ □ What is your White ethnicity? □ □ English Northern Irish Please tick the □ □ British appropriate box: □ □ Scottish Irish Any other white background □ (please state) Traveller Black □ □ Gypsy / Roma Black or Black British Traveller of □ □ Caribbean Descent Other member of the □ □ African travelling community Asian Mixed □ □ Asian or Asian British White and Black Caribbean □ □ Indian White and Black African □ □ Pakistani White and Asian Any mixed background (please □ □ Bangladeshi state) □ Chinese
What is your sexual orientation? Please tick the appropriate box: Heterosexual □ Gay □ Lesbian □ Bisexual □ What is your ethnicity? Please tick the appropriate box: White English □ Northern Irish □ □ British □ Scottish □ Irish □ Any other white background (please state) □ Traveller Black Gypsy / Roma □ Black or Black British □ Traveller of Descent □ Caribbean □ Other member of the travelling community □ African □ Asian Mixed Asian or Asian British □ White and Black Caribbean □ Indian □ White and Black African □ Pakistani □ White and Asian Any □ Bangladeshi □ mixed background (please state) □ Chinese □
CDHG-Application-Form-Sept-15.docx