One of the aims of the Community Gateway Association is to “put our diverse communities at the heart of all we do”. In order to help the association fulfil this value we are constantly reviewing our ethnicity and diversity information to ensure that we give the best possible service to everyone.
The Community Gateway Association would be grateful if you could spend a few minutes completing this questionnaire. All information provided is treated confidentially. Information is retained by the Community Gateway Association for monitoring purposes only and is not disclosed to any external agency or person(s).
Please note: this section is optional.
I am: MaleFemale
Please state what you consider to be your ethnic origin:
White BritishWhite IrishWhite - otherBlack or Black British - AfricanBlack or Black British - CaribbeanBlack or Black British - otherAsian or Asian British - IndianAsian or Asian British - PakistaniAsian or Asian British - BangladeshAsian or Asian British - otherMixed White and Black AfricanMixed White and Black CaribbeanMixed White and AsianMixed - otherOther ethnic origin - ChineseOther ethnic origin - other groups
Please specify origin
Please state what you consider to be your faith:
Prefer not to giveBahaiBuddhistChristian faithsHinduJudaismMuslimPaganRastafarianSikhNo faithOther
Please specify faith
What is your main language preference?
BengaliEnglishFarsiGujaratiHinduPolishPunjabiUrduOther
Please specify preference
How would you prefer the Community Gateway Association to contact you?
EmailLetterPersonal visitPhoneSMS (text)TranslatorOther
Do you consider yourself to have a disability or impairment?
YesNo
Please explain how you are affected below:
MobilityHearingVisionPartial sightWheelchair userLiteracyOther
Please give details
Do you have any of the following needs?
Audio tape versions of documentsBraille versions of documentsLarge print documentsKnock loudly when visiting your homeWheelchair access if I visit CGA premisesOther
Please state what you consider to be your sexuality:
BisexualGay maleHeterosexualLesbianPrefer not to sayOther