Literature Wales aims to provide fair and equal access to all its activities. This questionnaire will help us monitor the effectiveness of our Equality Policies, and how we are complying with the 2010 Equality Act. Completion of this anonymous form is voluntary. Please return all completed forms to Literature Wales.

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* 1. What is your gender?

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* 2. What is your age?

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* 3. What is your nationality?

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* 4. What is your ethnic group?

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* 5. Do you have any long-standing physical or mental health condition, illness, impairment or disability?
(i.e. has lasted or is expected to last at least 12 months and adverse effect on your ability to carry out normal day-to-day activities.)

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* 6. Can you understand, speak, read and / or write Welsh? (please rate your level of fluency (1 least fluent - 4 most fluent

1 4
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i We adjusted the number you entered based on the slider’s scale.

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* 7. Can you understand, speak, read and / or write English? (please rate your level of fluency (1 least fluent - 4 most fluent

1 4
Clear
i We adjusted the number you entered based on the slider’s scale.

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* 8. Please state any other languages you can understand, speak, read and/or write

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* 9. Are you?

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* 10. If not in employment, are you?

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* 11. Would you say your annual household income is

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* 12. What is your postcode?

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* 13. Where did you hear about this opportunity?

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