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What is your gender ?
Please state if you have any long-term physical or mental condition that
affects your ability to carry out day-to-day activities. (Advice can be obtained from the
Disability Rights Commission 08457 622 633)
Please state your age and date of birth:
Date of birth
Please indicate your sexual orientation:
The following categories are based on those used
in the 2001 census as recommended by the CRE. Please note the ethnic
questions are not about nationality, place of birth or citizenship. UK
citizens can belong to any of the ethnic categories indicated.
Please tick the box below which best describes the ethnic category to which you belong: