CAMPAIGN AGAINST DISCRIMINATION

This survey will have the purpose of gathering the annual report regarding the frequency of discrimination cases, intolerance based on dress code, musical preferences and lifestyle.

Please participate and complete it to help in our fight against discrimination.
The questionnaire lasts about 10 minutes.

We are waiting for your answers. Thank you!

In order to be able to contact you in case you want the solving of a possible case please leave us your contact data. These data are strictly confidential(won’t be made public or used in commercial purposes). This answer is optional.

1. Please fill in the following personal data:

First Name:
Last Name:
Age:
City:
District:
Country:
Phone number:
E-mail address:

I would like to start with several questions about you. This information are strictly confidential and are going to be used only in answer classification.

2. You are a:

	pupil
	student
	worker
	free lancer

3. What kind of cultural activities are you attending in your free time:

	none
	painting
	reading
	music
	prose, poetry
	specializing in a musical instrument
	other