INDUSTRY ACCESS PROGRAM - CAMBS YOUNG PERSON DETAILS OK Question Title * 1. Class name (If relevant) OK Question Title * 2. Full Name OK Question Title * 3. Gender Male Female OK Question Title * 4. Date of Birth Date Date OK Question Title * 5. Nationality OK Question Title * 6. Home & Mobile Telephone Home Mobile OK Question Title * 7. Email Address OK Question Title * 8. Confirm Email Address OK Question Title * 9. Address Address – 1st Line * Address – 2nd Line Town or City * ZIP/Postal Code * OK Question Title * 10. Household Status No household member is in employment and household includes one or more dependents (aged 0-17yrs and or 18-24yrs) No household member is in employment and the household does not include any dependent children or students I live in a single household with dependent children None of these apply OK Question Title * 11. National Insurance Number OK Question Title * 12. Parent/ Guardian details Name Relationship Address Address 2 City/Town ZIP/Postal Code Email Address Phone Number OK ETHNCITY/RELIGION OK Question Title * 13. Ethnicity White British White Irish White other Mixed W/B Caribbean Mixed W/B African African Other multiple mix Indian Pakistani Bangladeshi Chinese Caribbean Other Asian background Other black background Other black background Other Prefer not to say I do not know OK Question Title * 14. SUPPORT/LEARNING NEEDS Yes No Are you in care? Are you in care? Yes Are you in care? No Are you a refugee/migrant? Are you a refugee/migrant? Yes Are you a refugee/migrant? No Do you consider yourself to have a disability or learning difficulty? Do you consider yourself to have a disability or learning difficulty? Yes Do you consider yourself to have a disability or learning difficulty? No Are you homeless? Are you homeless? Yes Are you homeless? No OK NEXT