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Do you live or work in Pembrokeshire, Ceredigion or Carmarthernshire? (please tick all that apply)

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	Options Count Options Count Prefer not to say 0 Live in Pembrokeshire 0 Work in Pembrokeshire 0 Live in Ceredigion 0 Work in Ceredigion 0 Live in Carmarthenshire 0 Work in Carmarthenshire 0 I don’t live or work in any of these areas 0

Would you like to receive feedback on the outcome of this exercise?

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	Options Count Options Count Prefer not to say 0 Yes by email 0 No thank you 0

What is your age?

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	Options Count Options Count 18 to 24 0 25 to 34 0 35 to 44 0 45 to 54 0 55 to 64 0 65 to 74 0 75 or older 0 Prefer not to say 0

Which race or ethnicity best describes you?

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	Options Count Options Count Prefer not to say 0 White: British 0 White: Irish 0 White: European 0 Asian / British Asian: Bangladeshi 0 Asian / British Asian: Chinese 0 Asian / British Asian: Indian 0 Asian / British Asian: Pakistani 0 Black/ British Black: African 0 Black/ British Black: Caribbean 0 Mixed Race: Black & White 0 Mixed Race: Asian & White 0 Gypsy / Traveller 0 Another race or ethnicity - please specify 0 Other 0

Which of the following terms best describes your sexual orientation?

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	Options Count Options Count Prefer not to say 0 Bisexual 0 Gay 0 Heterosexual or straight 0 Lesbian 0 Other 0

What is your gender?

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	Options Count Options Count Prefer not to say 0 Female 0 Male 0 Transgender 0

Are you currently pregnant?

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	Options Count Options Count Prefer not to say 0 Yes 0 No 0

Do you currently have a child of less than 24 months old?

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	Options Count Options Count Prefer not to say 0 Yes 0 No 0

Do you have a disability, long-term health illness or health condition?

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	Options Count Options Count Prefer not to say 0 Yes 0 No 0

Do you have any caring responsibilities? (please tick all that apply)

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	Options Count Options Count Prefer not to say 0 None 0 Primary carer of a disabled child or children 0 Primary carer or assistant for an older person or people (65 years and over) 0 Primary carer of a child or children (under 2 years) 0 Primary carer or assistant for a disabled adult (18 years and over) 0 Secondary carer ( another person carries out main caring role) 0 Primary carer of a child or children (between 2 years and 18 years )) 0

Please specify what your interest is in this project?

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Please tell us your race

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if you would like to explain further please comment below

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Full Name Title

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Email Address Title

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