Arcola 50+ Expression of Interest Form

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This is a compulsory form for all Arcola 50+ Members.
We use this information to report to Arts Council England and for internal and external evaluation (anonymised).
This information will not be used for discriminatory purposes.
All information is confidential and stored in accordance with Arcola's Data Protection Policies and the Data Protection Act.

First Name *

Surname *

Date of Birth *

YYYY

Email Address *

Postcode *

My preferred gender pronoun/s are? *

I identify my sexual orientation as... *

Asexual

Bisexual

Gay

Straight (heterosexual)

Lesbian

Pansexual

Queer

Questioning or unsure

An identity not listed

Prefer not to say

Ethnic Origin *

White - British

White - Irish

Any other white background

Mixed - White and Black Caribbean

Mixed - White and Black African

Mixed - White and Asian

Mixed - Any other mixed/multiple ethnic background

Asian or Asian British - Indian

Asian or Asian British - Pakistani

Asian or Asian British - Bangladeshi

Asian or Asian British - Sri Lankan

Asian or Asian British - Chinese

Asian or Asian British - Any other Asian background

Black or Black British - Caribbean

Black or Black British - African

Black or Black British - Any other Black Background

Other

Prefer not to say

Do you consider yourself to have a disability or are you affected by any medical condition we should know about (eg epilepsy, diabetes, allergies)? If yes, please give details as appropriate. *

Do you require any additional support? *

Physical/Mobility

Hearing Impairment

Learning Difficulties

Visual Impairment

English Language Support

Mental Health difficulties

No additional support

If applicable, please indicate the nature of your support needs.

How would you like to take part?

As a performer

Devising or Writing (but not performing)

Supporting the creation of the show/projects (behind the scenes)

Interested in knowing more

Other:

Other skills, interests or connections I can volunteer....

Anything else we should know....

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