Equality and diversity questionnaire Question Title * 1. Are you... Male Female Prefer not to say Question Title * 2. Your age 24 or below 25-34 35-44 45-54 55-64 65- 74 75 or above Prefer not to say Question Title * 3. Do you consider yourself to have a disability? Yes No Don't Know / Prefer not to say DisabilityThe Equality Act 2010 defines a person as having a disability if s/he 'has a long-term physical or mental impairment which has a substantial and long-term adverse effect on his/her ability to carry out normal day to day activities'. Question Title * 4. What is your religion? Christian Muslim Hindu Sikh Buddhis Jewish No religion Other Prefer not to say Question Title * 5. What is your sexual orientation? Bisexual Gay man Gay woman/ Lesbian Heterosexual/ Straight Other Prefer not to say Question Title * 6. What is your marital status? Married Single Separated Divorced Widowed Other Prefer not to say Question Title * 7. Are you currently pregnant or have given birth in the last 12 months? Yes No Prefer not to say Question Title * 8. To which of these ethnic groups do you consider that youbelong?White English / Welsh / Scottish / Northern Irish / British Irish Gypsy / Irish Traveller Any other White ethnic group Question Title * 9. Mixed / Multiple White & Black Caribbean White & Black African White & Asian Any other Mixed/Multiple ethnic group Question Title * 10. Asian / Asian British Indian Pakistani Bangladeshi Chinese Any other Asian / Asian British ethnic group Question Title * 11. Black / Black British African Caribbean Any other Black / Black British ethnic group Question Title * 12. Other Arab Any other Other ethnic group Done