Cardiff Council wants to ensure that our projects meet the needs of a wide range of people.
What was your age on your last birthday? Under 16 16-24 25-34 35-44 45-54 55-64 65-74 75+
Are you…? Female Male Non-binary Other Prefer not to say
If ‘other’ please specify
Do you identify as Trans? Yes No Prefer to self describe Prefer not to say
If you prefer to self describe please specify
Are you pregnant, or have you given birth within the last 26 weeks? Yes, I'm pregnant Yes, I've given birth No prefer not to say
Do you identify as a disabled person? Yes No Prefer not to say
Please tick any of the following that apply to you: Deaf/Deafened/Hard of Hearing Mental Health difficulties Learning Impairment/difficulties Visual Impairment Wheelchair User Mobility Impairment Long-Standing Illness or health condition (e.g cancer, diabetes or asthma) Prefer not to say Other
Do you regard yourself as belonging to any particular religion? No, no religion Buddhist Christian (including Church in Wales, Catholic, Protestant and all other Christian denominations) Hindu Jewish Muslim Sikh Other Prefer not to answer
How would you describe your sexual orientation? Bisexual Gay Woman/Lesbian Gay Man Heterosexual/Straight Other Prefer not to answer
If ‘other’ please specify
Are you: Single In a same sex civil partnership Married Living Together/Co-habiting Separated/divorced or legally separated if formerly in a same sex civil partnership Widowed Other
Do you speak, read, understand or write in Welsh? Yes No
Do you speak, read, understand or write in any other language (except English)? Yes No
If ‘yes’ please specify
What is your ethnic group? White Welsh/English/Scottish/Northern Irish/British White - Irish White - Gypsy or Irish Traveller White - Any other white background Mixed/Multiple Ethnic Groups - White & Asian Mixed/Multiple Ethnic Groups - White and Black Caribbean Mixed/Multiple Ethnic Groups - White and Black African Mixed/Multiple Ethnic Groups - Any other Asian/Asian Welsh/British - Bangladeshi Asian/Asian Welsh/British – Chinese Asian/Asian Welsh/British - Indian Asian/Asian Welsh/British - Pakistani Asian/Asian Welsh/British - Any other Black/African/Caribbean/Black Welsh/British - African Black/African/Caribbean/Black Welsh/British – Caribbean Black/African/Caribbean/Black Welsh/British - Any other Arab Any other ethnic group Prefer not to say
If ‘Any other ethnic group’ please specify
