INDUSTRY ACCESS PROGRAM - CAMBS

YOUNG PERSON DETAILS

Question Title

1. College and Class name (If relevant)

Question Title

2. Full Name (Required.)

Question Title

3. Gender (Required.)

Male

Female

Question Title

4. Date of Birth (Required.)

Date

Question Title

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:

Question Title

6. Home & Mobile Telephone

Home

Mobile

Question Title

7. Email Address (Required.)

Question Title

8. Confirm Email Address

Question Title

9. Address (Required.)

Address – 1st Line *

Address – 2nd Line

Town or City *

ZIP/Postal Code *

Question Title

10. Household Status (Required.)

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

Question Title

11. National Insurance Number

Question Title

12. Parent/ Guardian details

Name

Relationship

Address

Address 2

City/Town

ZIP/Postal Code

Email Address

Phone Number

ETHNCITY/RELIGION

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

Prefer not to say

I do not know

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

INDUSTRY ACCESS PROGRAM - CAMBS

Question Title

* 1. College and Class name (If relevant)

Question Title

* 2. Full Name (Required.)

Question Title

* 3. Gender (Required.)

Question Title

* 4. Date of Birth (Required.)

Question Title

* 5. What is your race or ethnicity?

Question Title

* 6. Home & Mobile Telephone

Question Title

* 7. Email Address (Required.)

Question Title

* 8. Confirm Email Address

Question Title

* 9. Address (Required.)

Question Title

* 10. Household Status (Required.)

Question Title

* 11. National Insurance Number

Question Title

* 12. Parent/ Guardian details

Question Title

* 13. Ethnicity

Question Title

* 14. SUPPORT/LEARNING NEEDS

1. College and Class name (If relevant)

2. Full Name (Required.)

3. Gender (Required.)

4. Date of Birth (Required.)

5. What is your race or ethnicity?

6. Home & Mobile Telephone

7. Email Address (Required.)

8. Confirm Email Address

9. Address (Required.)

10. Household Status (Required.)

11. National Insurance Number

12. Parent/ Guardian details

13. Ethnicity

14. SUPPORT/LEARNING NEEDS