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Entries with a yellow background are required.

About you
I have had PPI am a husband/partnerI am a family member/friendI am a health professional/studentI am a researcher/academicI am a journalist/work in the mediaI am considering pregnancy/pregnant with an increased risk of PPI am an APP supporterOther:
Big Lottery questions

We are required to ask some questions by our funders, the Big Lottery, for equality monitoring purposes please don’t be put off by these quite personal questions – feel free to tick the ‘Prefer not to answer this question’ option if you want to.

YesNoPrefer not to answer this question

NB. The Equality Act 2010 defines a disabled person as someone who has a mental or physical impairment that has a substantial and long-term adverse effect on their ability to carry out normal day-to-day activities

English/Scottish/Welsh/Northern Irish//UKIrishGypsy or Irish travellerAny other white backgroundIndianPakistaniBangladeshiChineseAny other asian backgroundAfricanCaribbeanAny other Black/African/Caribbean backgroundArabMixed ethnic backgroundOther ethnic groupPrefer not to answer this question
No religionChristian,BuddhistHinduJewishMuslimSikhOther religionPrefer not to answer this question
Towards someone of the same sexTowards someone of a different sexTowards someone of the same sex and the opposite sexPrefer not to answer this question
APP Network volunteering
FundraisingSupporting people affected by PPRaising awarenessTelling my storyBeing a local representative for APP (see below)Taking part in researchOther:

NB. Being a local representative for APP involves raising PP awareness, campaigning, fundraising and offering support in your local area.