White background Any Other Ethnic Background □ (specify if you wish) Any Other Ethnic Background □ (specify if you wish) ……………………………………………… ………………………………………………… And which group does your nominee for an award identify with? Please tick one box Asian Black Bangladeshi African □ □ Indian Caribbean □ □ Pakistani Any Other Black Background □ □ (specify if you wish) Any Other Asian Background □ (specify if you wish) ……………………………………………. Mixed Ethnic Background ……………………………………….. Chinese Asian and White □ Any Chinese Background Black African and White □ □ (specify if you wish)
□ White background Any Other Ethnic Background (specify if you wish) □ Any Other Ethnic Background (specify if you wish) ……………………………………………… ………………………………………………… And which group does your nominee for an award identify with? Please tick one box Asian Black □ Bangladeshi □ African □ Indian □ Caribbean □ Pakistani □ Any Other Black Background (specify if you wish) □ Any Other Asian Background (specify if you wish) ……………………………………………. ……………………………………….. Mixed Ethnic Background Chinese □ Asian and White □ Any Chinese Background □ Black African and White (specify if you wish)
Easy_Read_Nomination_for_a_National_Democracy_Week_Award__1_.docx