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Talking Points Engagement Form
Talking Points Engagement Form
Step
Of
Name:
Surname:
Email:
Tallking Points
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Your details
Step
Of
Spektrix ID
Session ID
Postcode
Date of birth
Gender (self-identified)
Please select
Male (including trans male)
Female (including trans female)
Non binary
Prefer not to say
If you would prefer to self-define your gender please enter details here
Is your gender identity the same one you were assigned at birth?
Please select
Yes
No
Prefer not to say
Sexual Orientation
Please select
Bisexual
Gay man
Gay woman/lesbian
Heterosexual/Straight
Prefer not to say
If you would prefer to self-define your sexuality please enter details here
Disability: Please state which of the following you consider applies to you
Please select
Don’t identify as disabled
Visual impairment
Hard of hearing /deafened
Deaf
Physical or mobility impairment
Cognitive or learning disabilities
Experience of a mental health condition
Restricted growth
Living with HIV
Prefer not to say
If you would prefer to self-define your disability status please enter details here here
Which do you consider your ethnicity to be?
Please select
White British
White Irish
White Gypsy/Traveller
Any other white background
Mixed British – White and Black Caribbean
Mixed British– White and Black African
Mixed British– White and Asian
Mixed British– Any other mixed background
Asian/Asian British – Indian
Asian/Asian British – Pakistani
Asian/Asian British – Bangladeshi
Asian/Asian British – Chinese
Asian/Asian British – Any other Asian background
Black/Black British – African
Black/Black British – Caribbean
Black/Black British – Any other Black background
Other – Arab
Other – Any other ethnic group
Other – prefer not to say
Other – not known
you would prefer to self-define your ethnicity please enter details here
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