Do you consider yourself to have a disability/learning difficulty/health condition? * Please choose... No Yes
Primary: * Please choose... Visual Impairment Hearing Impairment Disability Affecting Mobility Profound Complex Disabilities Social Emotional Difficulties Mental Health Difficulty Moderate Learning Difficulty Severe Learning Difficulty Dyslexia Dyscalculia Autism Spectrum Disorder Asperger’s Syndrome Temporary Disability Speech, Language & Communication Needs Other Physical Disability Other Specific Learning Difficulty (e.g. Dyspraxia) Other Medical Condition (e.g. epilepsy, asthma, diabetes) Other Learning Difficulty Other Disability Prefer Not to Say
Option 2: Visual Impairment Hearing Impairment Disability Affecting Mobility Profound Complex Disabilities Social Emotional Difficulties Mental Health Difficulty Moderate Learning Difficulty Severe Learning Difficulty Dyslexia Dyscalculia Autism Spectrum Disorder Asperger’s Syndrome Temporary Disability Speech, Language & Communication Needs Other Physical Disability Other Specific Learning Difficulty (e.g. Dyspraxia) Other Medical Condition (e.g. epilepsy, asthma, diabetes) Other Learning Difficulty Other Disability Prefer Not to Say
Option 3: Visual Impairment Hearing Impairment Disability Affecting Mobility Profound Complex Disabilities Social Emotional Difficulties Mental Health Difficulty Moderate Learning Difficulty Severe Learning Difficulty Dyslexia Dyscalculia Autism Spectrum Disorder Asperger’s Syndrome Temporary Disability Speech, Language & Communication Needs Other Physical Disability Other Specific Learning Difficulty (e.g. Dyspraxia) Other Medical Condition (e.g. epilepsy, asthma, diabetes) Other Learning Difficulty Other Disability Prefer Not to Say
Option 4: Visual Impairment Hearing Impairment Disability Affecting Mobility Profound Complex Disabilities Social Emotional Difficulties Mental Health Difficulty Moderate Learning Difficulty Severe Learning Difficulty Dyslexia Dyscalculia Autism Spectrum Disorder Asperger’s Syndrome Temporary Disability Speech, Language & Communication Needs Other Physical Disability Other Specific Learning Difficulty (e.g. Dyspraxia) Other Medical Condition (e.g. epilepsy, asthma, diabetes) Other Learning Difficulty Other Disability Prefer Not to Say
Option 5: Visual Impairment Hearing Impairment Disability Affecting Mobility Profound Complex Disabilities Social Emotional Difficulties Mental Health Difficulty Moderate Learning Difficulty Severe Learning Difficulty Dyslexia Dyscalculia Autism Spectrum Disorder Asperger’s Syndrome Temporary Disability Speech, Language & Communication Needs Other Physical Disability Other Specific Learning Difficulty (e.g. Dyspraxia) Other Medical Condition (e.g. epilepsy, asthma, diabetes) Other Learning Difficulty Other Disability Prefer Not to Say
Please select your ethnic origin: * Please choose... African Arab Bangladeshi British Caribbean Gypsy or Irish Traveller Indian Irish Other Asian background Other Black background Other Chinese Other Mixed background Other White background Pakistani White & Asian White & Black African White & Black Caribbean Other Not known / Prefer not to say
Please specify your ethnic origin: *
Please select the highest level of qualification you currently hold: * Please choose... No Qualifications Entry Level – Word Power/Number Power Other Qualifications – Below Level 1 Level 1 – GCSE/O Level grades D-G or 1-3 (or fewer than 5 at grades A-C or 4-9), GNVQ Foundation, CSE below grade 1, NVQ 1 Full Level 2 – 5 or more GCSE/O Level grades A-C or 4-9, 5 or more CSE Grade 1, NVQ 2, GNVQ Intermediate, 1st Diploma Full Level 3 – 2 or more A Levels, 4 or more AS Levels, NVQ 3, AVCE, National Diploma or Certificate Level 4 – HNC, CMS, NVQ 4 Level 5 – HND, First Degree, Foundation Degree Level 6 – Bachelors Degree, Award/Certificate/Diploma Level 6 Level 7/8 – Doctorates, Masters Degree, Award/Certificate/Diploma Level 7
Name of Highest Qualification: *
Employment Status: * Please choose... Employed Not Employed
Employment type: * Please choose... In paid employment – 0–10 hours per week In paid employment – 11–20 hours per week In paid employment – 21–30 hours per week In paid employment – 31 hours or more per week Self employed
Hours worked per week: * Please choose... 0–10 hours 11–20 hours 21–30 hours 31 hours or more
Unemployed type: * Please choose... Not in paid employment and looking for work Not in paid employment and not looking for work In full-time education prior to the start of the course Retired
How long have you been unemployed? * Please choose... Less than 6 months 6 - 11 months 12 - 23 months 24 - 35 months 36 months or more
Form of ID given: Please choose... Driving Licence Passport Birth Certificate National Identity Card
Preferred contact method: Please choose... Text Phone Email
