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Arcola Mental Health Theatre Company Expression of Interest Form
This is a compulsory form for all Mental Health Theatre Company 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.
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* Indicates required question
First Name
*
Your answer
Surname
*
Your answer
Date of Birth
*
MM
/
DD
/
YYYY
Email Address
*
Your answer
Postcode
*
Your answer
I identify my gender as...
*
Your answer
My preferred gender pronoun/s are?
*
Your answer
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.
*
Your answer
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.
Your answer
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....
Your answer
Anything else we should know....
Your answer
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