Equal Opportunities Monitoring In line with UK legislation and good practice guidelines, we are asking everyone to complete this section. You are not obliged to provide any of the information in this section, but if you do so, it will enable us to monitor our business processes and ensure that we provide equality of opportunity to all. Name: Ethnicity Choose one selection from the list below to indicate your cultural Gender: background: Nationality: a] 1st Language: British Do you have a disability under the terms of the Disability Discrimination Act 1995 [a person with a Any other White background physical or mental impairment that affects you ability to carry out normal day to day activities which are substantial, b] Mixed adverse and long term]? White and Black Caribbean White and Black African Yes White and Asian No Any other mixed background What is your sexual orientation? c] Asian or Asian British Bisexual Indian Heterosexual Pakistani Lesbian or Gay Bangladeshi What is your religion or belief? Any other Asian background Buddhist Christian d] Black or Black British Caribbean Jewish African Muslim Any other Black background Sikh e] Chinese or other ethnic group Other religion/belief Chinese Indicate a more specific category here: Any other background Indicate a more specific category here: This information will be recorded electronically with your data in accordance with the Data Protection Act 1998, but used only for monitoring our business practices. Please return the completed application form to: Faculty of Dental Surgery Tel: 020 7869 6813/6814/6815 Education Department Fax: 020 7869 6818 35-43 Lincoln’s Inn Fields Email: fdseducation@rcseng.ac.uk London WC2A 3PE Web: Registered Charity No. 21808 7. Application Form For Student of Orthodontic Therapist 2016-2017 1. Surname First Name Date of GDC No. 2. Practice Address Postcode
Equal Opportunities Monitoring In line with UK legislation and good practice guidelines, we are asking everyone to complete this section. You are not obliged to provide any of the information in this section, but if you do so, it will enable us to monitor our business processes and ensure that we provide equality of opportunity to all. Name: Ethnicity Choose one selection from the list below to indicate your cultural background: a] British Any other White background b] Mixed White and Black Caribbean White and Black African White and Asian Any other mixed background c] Asian or Asian British Indian Pakistani Bangladeshi Any other Asian background d] Black or Black British Caribbean African Any other Black background e] Chinese or other ethnic group Chinese Any other background Indicate a more specific category here: Gender: Nationality: 1st Language: Do you have a disability under the terms of the Disability Discrimination Act 1995 [a person with a physical or mental impairment that affects you ability to carry out normal day to day activities which are substantial, adverse and long term]? Yes No What is your sexual orientation? Bisexual Heterosexual Lesbian or Gay What is your religion or belief? Buddhist Christian Jewish Muslim Sikh Other religion/belief Indicate a more specific category here: This information will be recorded electronically with your data in accordance with the Data Protection Act 1998, but used only for monitoring our business practices. Please return the completed application form to: Faculty of Dental Surgery Tel: 020 7869 6813/6814/6815 Education Department Fax: 020 7869 6818 35-43 Lincoln’s Inn Fields Email: fdseducation@rcseng.ac.uk London WC2A 3PE Web: Registered Charity No. 21808 7. Application Form For Student of Orthodontic Therapist 2016-2017 1. Surname First Name Date of GDC No. 2. Practice Address Postcode