About you

Title

First Name

Surname

Email Address

Daytime Telephone Contact Number

Alternative Contact Telephone Number

Please tell us which year you were born

Gender

How would you best describe your sexual orientation?

How would you best describe your ethnicity? *

Which of the following countries do you live in?

How long have you been living in the UK?

Which channel islands do you currently live on?

Are you a British National, that is, were you born and raised in the UK?

Yes

No

From which country do you originate?

Nearest major city/town to your location

Which Borough of London do in live in?

What is your current living status?

Do you have children?

What are the age(s) of your children? (please tick all that apply)

0 - 2

3 - 5

6 - 9

10 - 12

13 - 15

16 - 18

18+

Which of the following best describes your current living situation?