Tell us about yourself

Please help us by providing us with the following personal data. It will be used to ensure we provide a fair service to everyone and meet requirements placed upon the Council by Government. All personal information supplied by you on this form will be processed by Craven District Council in accordance with the Data Protection Act 1998. We will not sell or disclose your information to other organisations or individuals outside the Council without your consent.

Age

Under 11

11 - 14

15 - 17

18 - 24

25 - 34

35 - 44

45 - 54

55 - 64

65 - 74

75 or over

Gender

Male

Female

Ethnicity

(please note these categories are based on Census Classifications)

White - British

White - Irish

Other White background

Asian or Asian British - Indian

Asian or Asian British - Pakistani

Asian or Asian British - Bangladeshi

Asian or Asian British - Kashmiri

Other Asian background

Black or Black British - Caribbean

Black or Black British - African

Other Black background

Mixed - White and Black Caribbean

Mixed - White and Black African

Mixed - White and Asian

Other Mixed background

Chinese

Gyspy/Traveller

Other Ethnic Group

If you stated any other background or ethnic group - please tell us which background

Sexual orientation

Bisexual

Heterosexual/Straight

Lesbian/Gay

Disability

The Disability Discrimination Act (1995) considers a person disabled if: You have a longstanding physical or medical condition or disability that has lasted or is likely to last at least 12 months, and this condition or disability has a substantial adverse effect on your ability to carry out normal day-to-day activities.

Do you consider yourself to be disabled as set out under the Disability Discrimination Act (2005)?

Yes

Please indicate your type of impairment

Physical impairment impairment (such as difficulty using your arms, or mobility issues which means using a wheelchair or crutches)

Sensory impairment (such as being blind/having a serious visual impairment being deaf/having a serious hearing impairment)

Mental health condition (such as depression or schizophrenia)

Learning disability (such as Downs syndrome or dyslexia) or Cognitive impairment (such as autism or head-injury)

Long-standing illness or health condition (such as cancer, HIV, diabetes, chronic heart disease or epilepsy)

Other (please specify)

Religion and Belief

Buddhist

Christian

Hindu

Jewish

Muslim

Sikh

Humanist

No religion

Other (please specify)

Home Postcode

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