Have you ever been treated unfairly or been discriminated against because of your race? Please share your experiences, explaining what took place and what you thought was the root cause or reason for why you had to endure this behaviour or situation. How has your experience of race inequality or racial discrimination impacted your life and have your family and friends been affected too?

A negative experience linked to an individual's race can contribute to other factors, including and not limited to the quality of their life, housing conditions, health and mental welfare, ability to secure employment or steady income, success in education, lack of trust in statutory authorities or damage an individual's confidence.

Please describe in your own words what this impact was.

What are the three key statements or points of concern about racism/racial inequality that you would like to share with the Race Equality Commission?

Statement 1 Statement 2 Statement 3

If you had the power to bring about change that could protect people from encountering racial prejudice, racial inequality and/or racial discrimination what would you change and how?

Nearest Town Centre * - Please Select - Acton Chiswick Ealing Greenford Hanwell Northolt Park Royal Perivale Southall West Ealing Ethnicity * -- Please Select - English Welsh Scottish Northern Irish or British Irish Gypsy or Irish Traveller Any other White background White and Black Caribbean White and Black African White Asian Any other Mixed or Multiple background Indian Pakistani Bangladeshi Chinese Any other Asian background African African American Caribbean Any other Black background Arab Hispanic Latino Native American Pacific Islander Any other ethnic group Gender * - Please Select - Female Male Prefer not to say Prefer to self-describe Age * - Please Select - 18-24 years old 25-34 years old 35-44 years old 45-54 years old 55-64 years old 65-74 years old 75 years or older Disablity - Please Select - Yes No Don't know/Can't say Prefer not to say Sexual Orientation - Please Select - Heterosexual Lesbian Gay Bi-sexual Prefer not to say Other (please state) Occupation How did you hear about the Commission? * - Please Select - Website Social Media Around Ealing magazine Ealing News Extra Email Friends/Family Other