Some test content Paged survey form Step 1 of 3 33% Please confirm below whether we can use your email for the above purpose? Yes No First Name Last Name Your Email Your Postcode Which area(s) are you most interested in receiving information about? (Please tick all that apply) Peterborough East Cambs Fenland Entire Combined Authority region Huntingdonshire City of Cambs South Cambs The following optional questions ask for personal information about you. If you feel comfortable answering them, please do, but if you would prefer not to, you can select ‘prefer not to say’ on any question you don’t want to answer. We are required to act in line with the Equality Act 2010. By asking some questions about your background, we can see how much the profile of our Your Voice users (people with a Your Voice account who use the site to take part in consultation activities) reflects the demographic profile of the local population, and we can make sure our work reflects the diverse communities we serve. This helps us improve future consultations and engagement exercises.How old are you? 15 and under 16-24 25-34 35-44 45-54 55–64 65–74 85+ Prefer not to say What sex are you? Female Male Prefer not to say Is the gender you identify with the same as your sex registered at birth? Yes No I self-describe my gender identity Prefer not to say How would you describe your ethnicity or ethnic background? Asian / Asian British: Indian Asian / Asian British: Bangladeshi Asian / Asian British: any other Asian background Black or Black British: Caribbean Mixed or Multiple ethnic groups: White and Black Caribbean Mixed or Multiple ethnic groups: White and Asian White: English, Welsh, Scottish, Northern Irish or British White: Roma Other: Arab Prefer not to say Asian / Asian British: Pakistani Asian / Asian British: Chinese Black or Black British: African Black or Black British: Any other Black, African or Caribbean background Mixed or Multiple ethnic groups: White and Black African Mixed or Multiple ethnic groups: Any other Mixed or Multiple ethnic background White: Gypsy or Irish Traveller White: Any other White background Other: Any other ethnic group Do you have any physical or mental health conditions or illnesses lasting or expected to last 12 months or more? Yes No Prefer not to say Do any of your conditions or illnesses reduce your ability to carry out day-to-day activities? Yes, limited a lot Yes, limited a little No Prefer not to say How would you describe your sexual orientation? Heterosexual or straight Gay man or gay woman / lesbian Bisexual I self-describe my sexual orientation Prefer not to say What is your religion or belief? No religion or belief (including atheist) Buddhist Jewish Sikh Prefer not to say Christian (including Church of England, Catholic, Protestant, and all other Christian denominations) Hindu Muslim Other (specify below if you wish) Untitled Survey Field First Choice Second Choice Third Choice
