Young Leader Census return

Name of person completing this form*

First NameLast Name

Email of person completing this form*

example@example.com

Phone Number of person completing thsi from*

Area CodePhone Number

Your Group*

1: Total number of Young Leaders at your group who are ALSO a member of an Explorer Unit*

2:Total number of Young Leaders at your group who are NOT a member of an Explorer Unit*

Total number of Young Leaders in Group (Auto calculated)

Please complete the following boxes ONLY for the Young Leaders at your group who are NOT a member of an Explorer Unit.

You have entered {number30} above, therefore please ensure you have entered {number30} young leader details below.

Note: All grids below require an entry on at least one row. 0 is an accepted entry.

Young people*

Rows	Male	Female	Self-identity	Prefer not to say
13yrs
14yrs
15yrs
16yrs
17yrs

Ethnicity - Asian or Asian British*

Rows	Male	Female	Self-identity	Prefer not to say
Bangladeshi
Chinese
Indian
Pakistani
Any other Asian background

Ethnicity - Balck, Black British, Caribbean or African*

Rows	Male	Female	Self-identity	Prefer not to say
African background
Caribbean
Any other Black, Black British or Caribbean background

Ethnicity - White*

Rows	Male	Female	Self-identity	Prefer not to say
English, Welsh, Scottish, Northern Irish or British
Gypsy or Irish Traveller
Irish
Roma
Any other White background

Ethnicity - Mixed or Multiple ethnic groups*

Rows	Male	Female	Self-identity	Prefer not to say
White and Asian
White and Black African
White and Black Caribbean
Roma
Any other Mixed or Multiple ethnic background

Ethnicity - Other ethnic group*

Rows	Male	Female	Self-identity	Prefer not to say
Arab
Any other ethnic group

Ethnicity - Other

Rows	Male	Female	Self-identity	Prefer not to say
Prefer to self-describe
Prefer not to say

Relgion*

Rows	Male	Female	Self-identity	Prefer not to say
No religion
Buddist
Christian
Hindu
Jewish
Muslim
Sikh
Other
Prefer not to say

Disabilities

Developmental e.g.ADHD, ADD, Autism Spectrum Disorder, Developmental delay, Down's syndrome, Dyspraxia, Dyslexia,Speech or language difficulties, other learning difficulties*

Injury e.g. Long term affecting body or brain injuries*

Physical e.g. Spina bifida, other condition affecting mobility*

Medical e.g. Asthma, allergies (which may require medical intervention), cystic fibrosis, heart condition, migraines, epilepsy.*

Mental Health e.g. Anxiety, depression, panic attacks, history of self-harm, eating disorder*

Progressive e.g. Muscular dystrophy, multiple sclerosis*

Sensory e.g. Affected sight, hearing, taste or smell*

Self-describe*

None i.e. No disability*

Prefer not to say*

Total (Auto calculated)

ERROR: the total above does not equal the number of Young Leaders entered in question 2 above.

Additional questions.

(These are not counted towards capitation fees).

How many Bronze DofE volunteers do you have?*

How many Silver DofE volunteers do you have?*

How many Gold DofE volunteers do you have?*

Young Leader Census Form