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On-line Forms

Ethnic Origin, Gender and Disability Status Survey

CWU Head Office has asked us to find out the gender and ethnic origin of our members and if they consider they are disabled. This information is only intended to help the Union provide the best service to our members.

Items marked • must be filled in.

Your Details
• Name:
Membership No:
Email address:
Telephone:
• Employer:
• Gender:
Disability

• Do you consider yourself to have a disability?

Ethnic Origin

• Please select the ethnic group that you consider you belong to:

Black Afro-Caribbean
Black African
Black Asian, please specify:
Black Other
Oriental
White European
White Other
Other, please specify:
Send Your Details
 

Thank you.
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