Participant Personal Information Form

 

Name:

 

Date of Birth:                      (day/month/year)

 

Gender:           MALE/FEMALE/OTHER (please specify)

 

Nationality:

 

Region of origin within UK:

 

Did you spend your childhood (ages 4 – 15) living in the United Kingdom?       YES/NO

 

Occupation:

 

What is your ethnic group?

White

ENGLISH, WELSH, SCOTTISH, NORTHERN IRISH, OR BRITISH
IRISH
GYPSY OR IRISH TRAVELLER
ANY OTHER WHITE BACKGROUND, WRITE IN:

Mixed/multiple ethnic groups

WHITE AND CARIBBEAN
WHITE AND AFRICAN
WHITE AND ASIAN
ANY OTHER MIXED OR MULTIPLE ETHNIC BACKGROUND, WRITE IN:

Asian/Asian British

INDIAN
PAKISTANI
BANGLADESHI
CHINESE
ANY OTHER ASIAN BACKGROUND, WRITE IN:

African/Caribbean/Black/Black British

CARIBBEAN
AFRICAN
BLACK BRITISH
ANY OTHER AFRICAN, CARIBBEAN OR BLACK BRITISH BACKGROUND, WRITE IN:

Other ethnic group

ARAB
ANY OTHER ATHNIC GROUP, WRITE IN: