Self-Identification Form

Self Identification Information

First Name: Last Name:
Self Identification (select all that apply):
Member self-identification allows PETL to achieve a critical goal, supporting, and encouraging the participation of all members in PETL programs, services and events. By completing this section, PETL will be able to undertake the necessary statistical analysis to achieve this goal. All information collected and the reporting of statistical data will ensure full confidentiality of all members. Although the completion of this section is voluntary, PETL encourages members to self-identify.
First Nations Métis Inuit
Racialized group White/Caucasian
Woman Non-binary Man
Person with disability Non-disabled
Lesbian, Gay, Bisexual, Transgender, Queer or Questioning Heterosexual
If you identify as racialized, please specify (e.g. Black, East Asian, Mixed Race):
Non-Board Email: Worksite:
Accommodations: Dietary Restrictions:

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