Current Page 1 Page 2 Preview Personal information on this form is collected by the Executive Council Office under section 31(c) of the Freedom of Information and Protection of Privacy Act for program administration purposes. Questions regarding the collection or use of this information can be referred to the program coordinator at engagepei@gov.pe.ca. Identification Provide your civic address in the fields below. Salutation First Name Middle Initial Last Name Address 1 Address 2 City, Town, or Community Province Postal Code For example C1B 0X1 or 12345 Country Telephone Number For example 902-555-5555 Email Address County - Select -KingsQueensPrince Demographic Information We are committed to promoting diversity and inclusion within our Agencies, Boards, and Commissions to ensure they are representative of the richness of our Island community. While the following questions are optional, the information collected will help us identify any underrepresentation and enable us to adopt more inclusive engagement approaches with diverse populations across PEI. In support of increasing diversified representation, the information collected may also be used in the assessment of applications. All information collected will be kept confidential. Which gender(s) do you most identify? Check all that apply. Man Woman Transgender Man Transgender Woman Transgender Non-Binary Two-Spirit Non-Binary Gender not listed please specify Prefer not to answer Other, please specify Do you identify as a member of the 2SLGBTQIA+ community? - Select -YesNoPrefer not to answerI would like to provide more information Please provide more information. What are your preferred pronouns? What is your age category? - Select -Under 1818-2930-3940-4950-5960-6970 and overPrefer not to answer Do you have a disability or identify as a person living with a disability? - Select -YesNoNot surePrefer not to answer What language(s) do you regularly use? Do you know French or English well enough to read and understand a document and carry on a conversation? - Select -French OnlyEnglish OnlyFrench and EnglishNeither French nor English Do you identify as an Indigenous person of Canada (eg. First Nation, Métis, Inuit)? - Select -YesNoPrefer not to answer What is your residency status? - Select -Canadian CitizenPermanent ResidentInternational Student (Student Visa)RefugeeTemporary Foreign WorkerOpen Work PermitEmployer-Specific/Restricted Work PermitPrefer not to answer Which race and/or ethnic category best describes you? Check all that apply. Black (e.g. African/Afro-Caribbean/African Canadian descent) East/Southeast Asian (e.g. Cambodian/Chinese/Filipino/Indonesian/Japanese/Korean/Taiwanese descent/Thai/Vietnamese/other Southeast Asian descent) Indigenous (e.g. First Nations/Inuk/Inuit/Métis descent) Latinx (e.g. Latin American [Costa Rica/Cuba/Dominican Republic/El Salvador/Guatemala/Haiti/Honduras/Mexico/Panama/etc.] Hispanic descent) Oceania Pacific (e.g. Indigenous to Australia/Melanesia/Micronesia/New Zealand/Polynesia) South Asian (e.g. South Asian descent [Afghan/Bangladeshi/East Indian/Indo-Caribbean/Pakistani/Sri Lankan]) Southwest Asian/North African (e.g. Arab [e.g. Algerian/Egyptian/Lebanese/Saudi Arabian/Syrian] Kurdish/Persian/Turkish) White (e.g. European descent/Euro Canadian) Prefer not to answer