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Name*

Address Line 1*

Address Line 2

Town

Postcode*

E-mail*

Telephone*

Select Relevant Age Group*

18 years old or under

19 - 49 of age

Over 50 of age

Do you currently hold a mathematics qualification grade c or equivalent and above?*

Yes

No

Will you require any reasonable adjustments to support your attendance at this event?*

Ye

No

Event/Course Interested in*

Date Of Event*

Council/ College/ University

Gender*

To which Ethnic group do you belong?*

Marital Status*

What is your religious belief?*

Do you have dependants?*

Do you consider yourself to have a disability under the terms of the Disability Discrimination Act 1995, defined as a physical or mental impairment, which has a substantial and long term adverse effect on a person’s ability to carry out normal day to day activities?*

Which of the following options best describes your sexual orientation?*

(Optional) - Are you...?

GES2 Pre-project Questionnaire

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