The Inclusive Involvement Community

Introduction

As we grow, we want to ensure we are inclusive of people from all communities. To be able to do this, we need to know more about the profile of the people who sign up to our inclusive involvement community.

Please can you help us by completing an anonymous questionnaire? You can skip questions or state you would prefer not to say. It will take a couple of minutes.

Completing this anonymous questionnaire helps us to know who may be underrepresented among our subscribers and community. This questionnaire is voluntary and all data is collected anonymously and held in line with the General Data Protection Regulations (GDPR). Thank you.

If you have any questions about the form you can contact us via email at hello@shapingourlives.org.uk or by telephone at 0345 241 0383.

Question Title

* 1. How old are you?

Under 18 years

18 - 25 years old

26-35 years old

36 - 45 years old

46 - 55 years old

56 - 65 years old

66 - 75 years old

Over 75

Prefer not to say

Question Title

* 2. Where do you live?

East Midlands

East of England

London

North East

North West

South East

South West

West Midlands

Yorkshire and Humberside

Wales

Northern Ireland

Scotland

Outside the UK

Prefer not to say

Question Title

* 3. What is your gender?

Male

Female

Intersex

Non-binary

Prefer not to say

If you prefer to use your own gender identity please add this here:

Question Title

* 4. Is the gender you identify with the same as your gender registered at birth?

Yes

Prefer not to say

Question Title

* 5. What is your sexual orientation?

Heterosexual

Gay or lesbian

Bisexual

Pansexual

Asexual

Undecided

Prefer not to say

If you prefer to use your own sexual identity, please state it here;

Question Title

* 6. What is your ethnicity? Ethnic origin is not about nationality, place of birth or citizenship. It is about the group you feel you belong to.

Asian/British Asian - Bangladeshi

Asian/British Asian - Chinese

Asian/British Asian - Indian

Asian/British Asian - Pakistani

Black African

Black British

Black Caribbean

Mixed/multiple - white and Asian

Mixed/multiple - white and Black African

Mixed/multiple - white and Black Caribbean

White - English/Welsh/Scottish/Northern Irish/British

White - Gypsy or Irish Traveller

White - Irish

White - Roma

Any other ethnic group or background, please describe

Question Title

* 7. What is your religion or belief?

Buddhist

Christian

Hindu

Jewish

Muslim

Sikh

No religion or belief

Prefer not to say

Other (please specify)

Question Title

* 8. Do you consider yourself to have an impairment, disability or long-term health condition?

Yes

Prefer not to say

Question Title

* 9. Do you use, or have you used in the past:

Social care services

Health services

Both health and social care services

Neither

Prefer not to say

Question Title

* 10. Do you have caring responsibilities? A carer is anyone, including children and adults, who looks after a family member, partner or friend who needs help because of their illness, frailty, disability, a mental health problem or an addiction and cannot cope without their support. The care they give is unpaid.

Yes

Prefer not to say

Question Title

* 11. Do you take part in involvement activities to share your experiences of using services? This might be to improve services or as part of planning services or informing research.

Yes

Prefer not to say

Question Title

* 12. Do you organise involvement activities on behalf of health or social care services, a research organisation, or other community or third sector organisation?

Yes

Prefer not to say

Your survey responses won't be kept with your name, so all your answers will remain anonymous.
All data is collected anonymously and held in line with the General Data Protection Regulations (GDPR).