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Monitoring Form
We request the following information so that we can make sure all of our activities are reaching diverse groups of people. This information also helps us to evidence to our funders the work that we do, and is useful to us for getting future funding. We never use this information with any identifying information, we only share this information as statistics and numbers. Thank you very much for taking the time to fill it in.
Petedewfall1@hotmail.co.uk 
Email *
Where did you hear about the role?
LinkedIn 
Age *
What is your ethnicity? e.g. African, Caribbean, Indian, Pakistani, mixed/multiple ethnic groups (please describe)
White British 
 *
What is your nationality? e.g. Welsh, English, British
English 
 *
Do you identify as disabled?   *
Do you identify as Deaf or Hard of Hearing?   *
Do you identify as blind or partially sighted? *
Please describe your gender e.g. transgender, non-binary, male, female
Male
 *
How would you describe your sexual orientation? (e.g. queer, gay, lesbian, bisexual, asexual, heterosexual)
Heterosexual 
 *
Do you have caring responsibilities (e.g. do you look after a child, parent or older adult?) *
Are you a refugee or asylum seeker? *
Which languages do you speak fluently?
English 
 *
Which languages are you learning?
None
 *
What is your religion? (e.g. Muslim, Hindu, Christian, spiritual, no religion)
Agnostic 
 *
Please indicate where you consider to be your hometown (your principal residence up to age 18) and, if possible, postcode for that address.

Nailsea BS48
 *
Where do you live now (town and postcode ideally, or just town)?
Nailsea BS48
What are/were your parents’ (or primary carer’s) professions or last job (please give us an indication of the type of industry if the job title is generic such as ‘administrator’ or ‘director’)?
Father - Caretaker  
Mother - Civil servant 
 *
What is your highest level of completed education? *
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