Q1. Have you been a subjected to caste-related discrimination, harassment, bullying? YesNo
Q2. When did this take place?
Q3. Where did the caste-related discrimination, harassment, bullying take place?
Q4. In which setting did the caste-related discrimination, harassment, bullying take place? HomeWorkA place of worshipNHS, nursing home, GP Surgery, or domiciliary care settingSchoolUniversityElsewhere
Q5. Can you please give a brief account of what happened (Please limit to 500 words)
Q6. Have you reported the incident? YesNo
Q7. Did you get the help you needed? YesNo
Q8. Would you like the ACDA to contact you to discuss your case? YesNo
