Aboriginal Peoples

1. For the purposes of this survey, “aboriginal peoples” means persons who are North American Indian (status or non-status), First Nations, Inuit or Métis.

Question: Do you consider yourself an aboriginal person?

Yes No

Persons with Disabilities

2. For the purpose of this survey, “persons with disabilities” means persons who have a long-term or recurring physical, mental, sensory or learning impairment.

Question: Do you consider yourself a person with a disability?

Yes No

Member of Visible Minorities

3. For the purposes of this survey, “members of visible minorities” means persons, other than Aboriginal peoples, who identify themselves to be non-white in colour or of a non-Caucasian racial origin. Members of ethnic or national groups such as Portuguese, Italian, Greek, etc. are not considered to be racially visible. The visible minority groups include:

• Black (e.g. African, American, Canadian, Caribbean)
• East Asian (e.g. Chinese, Japanese, Korean, Polynesian)
• South Asian (e.g. Indian, Pakistani, Sri Lankan, Bangladeshi)
• Southeast Asian (e.g. Burmese, Cambodian, Filipino, Laotian, Malaysian, Thai, Vietnamese)
• West Asian (e.g. Arabian, Armenian, Iranian, Israeli, Lebanese, Palestinian, Syrian, Turkish)
• South or Central American-Indian
• Other (including mixed ancestry)

Question: Do you consider yourself a member of a visible minority?

Yes No

Members of Invisible Minorities

4. For the purpose of this survey, “members of invisible minorities” means persons whose minority status is not always immediately visible, such as some people with disabilities (i.e. HIV/AIDS), Poor Women, and/or the Lesbian, Bisexual, Transgender, Two-Spirited, Queer.

Question: Do you consider yourself a member of invisible minority?

Yes No

Communicative Skills

5. For the purpose of this survey and to improve our service delivery, please indicate the language(s) you are able to communicate in, verbally or written.

Language spoken at home: Please choose… English Farsi French Cantonese Italian German Mandarin Punjabi Spanish Portuguese Polish Arabic Tagalog (Philipino) Ukrainian Dutch Vietnamese Greek Cree Inuktitut (Eskimo) Urdu Other

Other Languages: (You can pick one or more)
No Fluency Understanding English
No Fluency Understanding Farsi
No Fluency Understanding French
No Fluency Understanding Cantonese
No Fluency Understanding Italian
No Fluency Understanding German
No Fluency Understanding Mandarin
No Fluency Understanding Punjabi
No Fluency Understanding Spanish
No Fluency Understanding Portugese
No Fluency Understanding Polish
No Fluency Understanding Arabic
No Fluency Understanding Tagalog (Philipino)
No Fluency Understanding Ukranian
No Fluency Understanding Dutch
No Fluency Understanding Vietnamese
No Fluency Understanding Greek
No Fluency Understanding Cree
No Fluency Understanding Inuktituk (Eskimo)
No Fluency Understanding Urdu
Other Language


NOTE: THE INFORMATION YOU ARE ASKED TO PROVIDE WILL BE HELD IN STRICT CONFIDENCE.