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Systemic Racism and Canada’s Health Research Funding System
1- Select the option that best describes your current gender identity.
Gender-fluid
Man
Nonbinary
Trans man
Trans woman
Two-Spirit
Woman
I don’t identify with any option provided.
I prefer not to answer
I identify as:
2a- Do you identify as Indigenous, that is, First Nation, Métis or Inuk (Inuit)?
Yes
No
I prefer not to answer
2b- If "Yes," select the group(s) that you identify with.
First Nations
Inuit
Métis
I prefer not to answer
3- Select the population group(s) you identify with.
Note: if you answered “Yes” to question 2a (i.e., you are an Indigenous person), select “Population group not listed above” for this question. You can also select from the list any other population group that applies to you.
Arab
Black
Chinese
Filipino
Japanese
Korean
Latin American
South Asian (e.g., East Indian, Pakistani, Sri Lankan, etc.)
Southeast Asian (e.g., Vietnamese, Cambodian, Laotian, Thai, etc.)
West Asian (e.g., Iranian, Afghan, etc.)
White
Population group not listed above.
I prefer not to answer
I identify as:
4a- The Accessible Canada Act defines disability as “any impairment, including a physical, mental, intellectual, cognitive, learning, communication or sensory impairment—or a functional limitation—whether permanent, temporary or episodic in nature, or evident or not, that, in interaction with a barrier, hinders a person’s full and equal participation in society.”
Do you identify as a person with a disability as described in the Act?
Yes
No
I prefer not to answer
4b- If “Yes,” select the type(s) of disability that applies to you.
Communications
Developmental
Dexterity
Flexibility
Hearing
Learning
Mental health-related
Memory
Mobility
Pain-related
Seeing
Disability not listed above.
I prefer not to answer
Disability: