Submerge Demographics Form

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This form is a place to provide anonymous demographic data for those who engage with Submerge. This data is used to report on activities to our funders, which helps us with internal reporting to ensure we are meeting the needs of all our communities. We greatly appreciate your contributions.

Date

YYYY

What is your current age?

What is the first part of your postcode or the town/city you live in? (i.e. M3 or Salford)

Which of the following best describes how you think of yourself?

Man (Including Trans Man)

Woman (Including Trans Woman)

Non-binary

In another way

Clear selection

In Another Way - Please provide details here

Which of the following best describes how you think of yourself?

Bisexual

Gay

Heterosexual / Straight

Lesbian

Queer

Other

Clear selection

Other - Please provide details here

Is your gender identity the same as the gender you were given at birth?

Yes

Clear selection

Would you describe yourself as intersex?

Yes

Clear selection

Do you consider yourself disabled?

Yes

Clear selection

What is your religion or belief?

Buddhist

Christian (inc. all denominations)

Hindu

Humanist

Jewish

Muslim

Sikh

Agnostic

No Religion (Atheist)

Other

Clear selection

Religion or Belief - Other

Which of the following best describes how you think of yourself?

Asian / Asian British Bangladeshi

Asian / Asian British Chinese

Asian / Asian British Indian

Asian / Asian British Pakistani

Any other Asian background

Black / African / Caribbean / Black British African

Black / African / Caribbean / Black British Caribbean

Any other Black / African / Caribbean background

Mixed / Multiple ethnic groups White and Black Caribbean

Mixed / Multiple ethnic groups White and Black African

Mixed / Multiple ethnic groups White and Asian

Any other Mixed / Multiple ethnic background

White English / Welsh / Scottish / Northern Irish / British

White Gypsy or Irish Traveller

White Irish

Any other White background

Any other ethnic group, please specify below

Clear selection

Any other ethnic group - please provide details here

Which of the following options best describes your employment status?

Student (Full Time)

Student (Part Time)

Employed (Full Time)

Employed (Part Time)

Unemployed (Eligible for Benefits)

Unemployed (Not Eligible for Benefits)

Self-employed

Retired

Clear selection

(Socio-Economic Background) Which type of school did you attend for the most time between the ages of 11 -16?

A state-run or state-funded school

Independent or fee-paying school

Attended school outside the UK

I don't know

Prefer not to say

Clear selection

(Socio-Economic Background) If you finished school after 1980, were you eligible for Free School Meals at anypoint during your school years?

Yes

Not applicable (finished school before 1980 or went to school overseas)

Don't know

Prefer not to say

Clear selection

(Socio-Economic Background) What is the highest level of qualification achieved by either of your parent(s)or guardian(s) by the time you were 18?

Degree level or Degree equivalent or above (first or higher degrees, postgraduate diplomas, NVQ/SVQ Level 4 or 5 etc.)

Qualifications below degree level (A-Level, SCE Higher, GCSE, O-Level, SCE Standard/Ordinary, NVQ/SVQ, BTEC etc.)

No Qualifications

I don't know

Prefer not to say

Not applicable

Clear selection

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