EQUAL OPPORTUNITIES MONITORING Date of Birth Male Female Transgender Prefer not to say Gender English Scottish Welsh Irish If please Specify ‘Other’ British MIXED White and If please specify White and Black Black White and Asian African Other Caribbean Ethnicity ASIAN or ASIAN BRITISH If please specify ‘Other’ Indian Bangladeshi Pakistani Other BLACK or BLACK BRITISH If please specify ‘Other’ African Caribbean Other ANY OTHER ETHNIC GROUP (please state) Bisexual Heterosexual Homosexual Prefer not to say Sexual Orientation Christian Catholic (all) Muslim Hindu Judaism Other None (all) If please specify ‘Other’ Religious Beliefs Do you consider yourself to have a disability as defined in current legislation? Yes Under current legislation, a disability is defined as a physical or mental impairment that has a substantial an long-term adverse effect on his or her ability to carry out day to day activities. In this definition, long No term is taken to mean more than twelve months and would cover long term illness such as cancer and HIV or mental health problems
EQUAL OPPORTUNITIES MONITORING Date of Birth Gender Male Female Transgender Prefer not to say Ethnicity English Scottish Welsh Irish British If ‘Other’ please Specify MIXED White and Black African White and Black Caribbean White and Asian Other If please specify ASIAN or ASIAN BRITISH Indian Bangladeshi Pakistani Other If ‘Other’ please specify BLACK or BLACK BRITISH African Caribbean Other If ‘Other’ please specify ANY OTHER ETHNIC GROUP (please state) Sexual Orientation Bisexual Heterosexual Homosexual Prefer not to say Religious Beliefs Catholic (all) Christian (all) Muslim Hindu Judaism Other None If ‘Other’ please specify Do you consider yourself to have a disability as defined in current legislation? Under current legislation, a disability is defined as a physical or mental impairment that has a substantial an long-term adverse effect on his or her ability to carry out day to day activities. In this definition, long term is taken to mean more than twelve months and would cover long term illness such as cancer and HIV or mental health problems Yes No