Any Asian Any other ethnic group (please □ □ background (please state) state) How you □ □ Christian Muslim describe your religion? □ □ Hindu Sikh □ □ Jewish Buddhist □ □ I am not religious Other (please state) Are you the primary □ □ Yes No carer for someone? If yes, do you care for? □ □ A child under 18 years A disabled Child under 18 of age years of age □ □ A disabled adult Another vulnerable person
Any Asian background (please state) □ Any other ethnic group (please state) □ How you describe your religion? Christian □ Muslim □ Hindu □ Sikh □ Jewish □ Buddhist □ I am not religious □ Other (please state) □ Are you the primary carer for someone? Yes □ No □ If yes, do you care for? A child under 18 years of age □ A disabled Child under 18 years of age □ A disabled adult □ Another vulnerable person □
CDHG-Application-Form-Sept-15.docx