INDUSTRY ACCESS PROGRAM - CAMBS

YOUNG PERSON DETAILS

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* 1. College and Class name (If relevant)

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* 2. Full Name

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* 3. Gender

Male

Female

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* 4. Date of Birth

Date

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* 5. What is your race or ethnicity?

31 English/Welsh/ Scottish/ Northern Irish

32 Irish

33 Gypsy or Irish Traveller

34 Any other white background

35 White and Black Caribbean

36 White and Black African

37 White and Asian

38 Any other mixed / multi ethnic background

39 Indian

40 Pakistani

41 Bangladeshi

42 Chinese

43 Any other Asian background

44 African

45 Caribbean

46 Any other Black /African /Caribbean

47 Arab

98 Any other ethnic group

Self-describe below:

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* 6. Home & Mobile Telephone

Home

Mobile

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* 7. Email Address

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* 8. Confirm Email Address

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* 9. Address

Address – 1st Line *

Address – 2nd Line

Town or City *

ZIP/Postal Code *

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* 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

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* 11. National Insurance Number

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* 12. Parent/ Guardian details

Name

Relationship

Address

Address 2

City/Town

ZIP/Postal Code

Email Address

Phone Number

ETHNCITY/RELIGION

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* 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

Prefer not to say

I do not know

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* 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