Customer Demographic Update

Member ID

Name

Demographic Questions

Do you consider yourself to have caring responsibilities? *

For what SCL classes as caring responsibilities see below:

Caring responsibilities can be:

Primary carer of a child/children (under the age of 18).

Primary carer of a child/children with a disability or long term health condition.

Primary carer of an adult with a disability or long term health condition (Aged 18 or over)

Primary carer of an older person.

Secondary carer (another person carries out the main carer role).

Do you have a disability? *

Condition/s area of your disability *

Please specify your "other" condition area of yours disability

Do you have a long-term health condition? *

Condition/s area of your long-term health condition?

Please specify your "other" condition area of yours long-term health?

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

Please specify your ethnicity

What is your first language? *

Please specify your first language

What is your Religion or Belief? *

Please specify your Religion or Belief?

Which of the following terms best describes your gender identity? *

Please specify your gender identity

Are you Transgender? *

What is your sexual orientation? *

Please specify your sexual orientation

Customer Demographic Update

Customer Demographic Update

Demographic Questions

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