Revitalise and Equal Opportunities Your ethnic originAsian, Asian British, Asian English, Asian Scottish, or Asian WelshArabBlack, Black British, Black English, Black Scottish, or Black WelshMixedWhiteOther ethnic groupPrefer not to sayThese categories are based on the Census 2011 categories and recommended by the Commission for Racial Equality.Asian, Asian British, Asian English, Asian Scottish, or Asian WelshAsian / Asian BritishBangladeshiChineseIndianPakistaniOther Asian backgroundAsian background (specify if you wish)Black, Black British, Black English, Black Scottish, or Black WelshAfricanCaribbeanOther Black backgroundBlack background (specify if you wish):WhiteBritishEnglishGypsy or Irish TravellerIrishScottishWelshOther White backgroundWhite background (specify if you wish):MixedWhite and AsianWhite and Black AfricanWhite and Black CaribbeanWhite and ChineseOther mixed backgroundMixed background (specify if you wish):Other ethnic group (specify if you wish):Your genderWomanManNon-binaryTransgenderIntersexTwo SpiritGender non-conformingOtherYour gender (specify if you wish):Your age16 - 2425 - 3435 - 4445 - 5455 - 6465+Prefer not to sayYour sexual orientationAsexualBisexualGayLesbianPansexualQueerQuestioning or unsureStraight (heterosexual)OtherYour sexual orientation (specify if you wish):Marriage and civil partnershipSingleMarried/in a registered civil partnershipSeparated, but still legally married/in a registered civil partnershipDivorced/formerly in a civil partnership which is now legally dissolvedWidowed/Surviving partner from a civil partnershipPrefer not to sayYour religion or beliefNo religionBuddhistChristian (including Church of England, Catholic, Protestant and all other Christian denominations)HinduJewishMuslimSikhPrefer not to sayOtherYour religion or belief (specify if you wish):Do you consider yourself to be disabled?YesNoPrefer not to sayThe Equality Act 2010 defines a disabled person as someone who has a physical or mental impairment which has a substantial and long-term adverse affect on their ability to carry out normal day-to-day activities.Please specify
