1. Are you male or female * (required)

---- ---- Male Female Do not wish to disclose

2. How old are you * (required)

3. To which ethnic group do you consider yourself to belong * (required)

---- White Mixed Asian or Asian British Black or Black British Chinese or Other Ethnic Group Do not wish to disclose

----

4. Are you an undergraduate or postgraduate student * (required)

---- ---- Undergraduate Postgraduate Do not wish to disclose

5. Which faculty are you in * (required)

---- ---- Art and Design Business, Environment and Society Engineering and Computing Health and Life Sciences Lifelong Learning Centre for the Study of Higher Education Do not wish to disclose

6. Are you a full time or part time student * (required)

---- ---- Full time Part time Do not wish to disclose

7. Are you a Home or EU or International student * (required)

---- ---- Home EU International Do not wish to disclose

8. How many times did you visit the GP last year * (required)

---- ---- 0 1-5 5+ Do not wish to disclose

9. Overall how would you rate your health during the past 4 weeks * (required)

---- ---- Excellent Very good Good Fair Poor Very poor Do not wish to disclose

10. Do you have a long-term physical or mental health problem or disability which requires regular contact with the health service * (required)

---- ---- Yes No Do not wish to disclose

Privacy notice

This form is anonymous. No data which personally identifies you is collected on the form, and the data you provide is used solely for the research purposes outlined in the Participant Information Sheet, dated 28/11/2008 (version 2).

The University of Warwick is the Data Controller of any information you have entered on this form and is committed to protecting the rights of individuals in line with Data Protection Legislation. The University's Data Protection webpages provide further information on your rights and how the University processes personal data. If you wish to submit a data subjects rights request, make a complaint or report a suspected personal data breach, please contact the University’s Data Protection Officer by email at infocompliance@warwick.ac.uk.