Diversity Information Collection
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Email Address
*
Please enter a valid email address.
This field is required.
This survey is only for monitoring our engagement with the community. Any published data will reflect the make-up of the whole membership, not individuals within it.
The following responses will be anonymous and not recorded against your identity. Your email address will be used to ensure that only one (most recent) response is included for each member and will never be published.
Age Group
*
Please select your age group.
Under 18
18-24
25-34
35-44
45-54
55-64
65-74
75 and over
Prefer not to say
This field is required.
Disability Status
Do you consider yourself to have a disability?
Yes
No
Prefer not to say
Ethnic Background
*
Please select your ethnic background.
Select an option
White
Mixed/Multiple ethnic groups
Asian or Asian British
Black, African, Caribbean or Black British
Other ethnic group
Prefer not to say
This field is required.
Gender
What is your gender? (Select all that apply)
Male
Female
Non-binary
Prefer not to say
Do you identify as LGBTQ+?
Please select any that apply.
Yes
No
Prefer not to say
Additional Comments
Please provide any additional information you would like to share.
Submit
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