Diversity Monitoring Survey
Age
Up to 24 years
25-34 years
35-44 years
45-54 years
55-64 years
65-74 years
75+ years
Prefer not to say
Do you consider yourself to have a disability or long-term health condition?
Yes
No
Prefer not to say
Which of the following would you consider to be your ethnic background?
Asian/ Asian British
Any other Asian background, please give details below
Black/ African/ Caribbean/ Black British
Any other Black/ African/ Caribbean background, please give details below
Mixed/ Multiple ethnic groups
Any other Mixed/ Multiple ethnic background, please give details below
White British
Any other White background, please give details below
Any other background, please give details below
Please add any additional information here
Which of the following best describes you/describes your gender:
*
Man
Non-binary
Woman
Prefer to self-describe
Prefer not to say