Language
English (UK)
Welsh (Cymraeg)
Equality and Diversity Form
'Lost Connections' is a community art project funded by Arts Council of Wales. This short questionnaire will help to collect basic data on project participants, for the use of funding reports. Data submitted is for monitoring purposes only and is anonymous.
What is your Age?
7-11
12-15
16-24
25-29
30-34
34-39
40-44
45-49
50-54
55-59
60-64
65+
What is your gender?
Female
Male
Non-Binary
Transgender
Prefer not to say
Other
What is your Nationality?
Welsh
British/ Mixed British
English
Scottish
Irish
Northern Irish
Prefer not to say
Other
What is your Ethnicity?
Arab
Asian / Asian British: Indian
Asian / Asian British: Pakistani
Asian / Asian British: Bangladeshi
Asian / Asian British: Chinese
Asian / Asian British: Any other Asian background
Any White background
Black / Black British: African
Black / Black British: Carribean
Black / Black British: Any other Black background
Mixed / Multiple ethnic groups: Asian & White
Mixed / Multiple ethnic groups: Black African & White
Mixed / Multiple ethnic groups: Black Carribean & White
Mixed / Multiple ethnic groups: Any other Mixed / Multiple ethnic background
Roma/ Irish Traveller
Prefer not to say
Other
Which area are you from? Please enter the first three digits of your postcode. E.g NP20
Can you understand, speak, read and /or write Welsh? Please rate your level of fluency
1
2
3
4
Least Fluent
Most Fluent
1 is Least Fluent, 4 is Most Fluent
Do you speak any other languages? If yes, add what languages here:
Do you have any access needs?
Yes
No
If yes, please can you explain further:
Thank you for your time!
Submit
Should be Empty: