Module Three - Breast Cancer Awareness

Welcome to the assessment for Module Three. Before you complete the assessment, please complete the equal opportunities and monitoring form below.

Why are we asking for this information? Leeds Health Awareness is committed to ensuring that our activities follow good practice in equality and inclusion. Some of the questions might feel strange, but the information lets us monitor which communities we are reaching. All information that you provide will remain anonymous. For our privacy statement please visit https://uniqueimprovements.com/privacy/

Question Title

1. What is your gender?

Female

Male

Prefer to self-describe

Prefer not to say

Question Title

2. Is your gender identity the same as the gender you were assigned at birth?

Yes

Question Title

3. What is your Ethnicity?

White

Black or Black British

Asian or Asian British

Mixed

Prefer not to say

Other (please specify)

Question Title

4. What is your Age?

Under 18

18-24

25-34

35-44

45-54

55-64

65+

Question Title

5. What is your Sexuality?

Heterosexual/Straight

Gay Man

Gay Woman/Lesbian

Bi-Sexual

Prefer to self-describe

Prefer not to say

Question Title

6. Do you consider yourself a carer?

Yes

Prefer not to say

Question Title

7. Do you consider yourself to have a disability?

Yes

Prefer not to say

Question Title

8. What is your Religion?

Buddhist

Christian

Hindu

Jewish

Muslim

Sikh

No Religion

Prefer not to say

Other (please specify)

Module Three - Breast Cancer Awareness

Question Title

* 1. What is your gender?

Question Title

* 2. Is your gender identity the same as the gender you were assigned at birth?

Question Title

* 3. What is your Ethnicity?

Question Title

* 4. What is your Age?

Question Title

* 5. What is your Sexuality?

Question Title

* 6. Do you consider yourself a carer?

Question Title

* 7. Do you consider yourself to have a disability?

Question Title

* 8. What is your Religion?

Question Title

* 9. What is your Location? Please provide the first part of your postcode? (I.e. LS11)

1. What is your gender?

2. Is your gender identity the same as the gender you were assigned at birth?

3. What is your Ethnicity?

4. What is your Age?

5. What is your Sexuality?

6. Do you consider yourself a carer?

7. Do you consider yourself to have a disability?

8. What is your Religion?

9. What is your Location? Please provide the first part of your postcode? (I.e. LS11)