UKYP Survey

1. The Boring Bits...

By completing this survey you have a chance to win £20 in Love to Shop vouchers!!

All the information you give helps towards getting young people's views heard in Oxfordshire.

1. Please enter your details below for a chance to win £20 worth of Love to Shop vouchers!

(All information provided is kept confidential)

Please enter your details below for a chance to win £20 worth of Love to Shop vouchers! (All information provided is kept confidential) Email Address:

2. Which Town do you live in/live closest to?

	Oxford City	North Oxfordshire	South Oxfordshire
Nearest Town	Which Town do you live in/live closest to? Nearest Town Oxford City	North Oxfordshire	South Oxfordshire

3. Are you?

Are you? Male

Female

4. Please enter your date of Birth

	DD		MM		YYYY
DOB	Please enter your date of Birth DOB Day	/	Month	/	Year

5. What is your Ethnic Origin?

	Asian or Asian British	White	Chinese	Dual Heritage	Black or Black British	Roma and Travellers	Other Ethnic Background
Ethnic Origin	What is your Ethnic Origin? Ethnic Origin Asian or Asian British	White	Chinese	Dual Heritage	Black or Black British	Roma and Travellers	Other Ethnic Background