White and Black Caribbean White and Black African Mixed and Multiple Ethnic White and Asian Groups Any other Mixed / Multiple Ethnic background, please write in Indian Pakistani Bangladeshi Asian / Asian British Chinese Any other Asian background, please write in African Black / African/ Caribbean Carribean / Black Any other Black / African / Caribbean background, please write in British Arab Other Ethnic Any other ethnic group, write in Group Prefer not to say How would you describe your sexuality? Homosexual / Prefer not to Heterosexual / Straight Bi-sexual Gay/Lesbian say How would you describe your religious beliefs? No Religion Jewish Christian Muslim Buddhist Sikh Hindu Any other religion, please specify Prefer not to say Do you consider yourself to have? (Tick all that apply) A Learning Disability Mental Ill Health
Mixed and Multiple Ethnic Groups White and Black Caribbean White and Black African White and Asian Any other Mixed / Multiple Ethnic background, please write in Asian / Asian British Indian Pakistani Bangladeshi Chinese Any other Asian background, please write in Black / African/ Carribean / Black British African Caribbean Any other Black / African / Caribbean background, please write in Other Ethnic Group Arab Any other ethnic group, write in Prefer not to say How would you describe your sexuality? Heterosexual / Straight Homosexual / Gay/Lesbian Bi-sexual Prefer not to say How would you describe your religious beliefs? No Religion Jewish Christian Muslim Buddhist Sikh Hindu Any other religion, please specify Prefer not to say Do you consider yourself to have? (Tick all that apply) A Learning Disability Mental Ill Health
Advocacy_under_the_Care_Act_-_Wakefield_Referral_Form_Jan_2016.docx