We are committed to eliminating discrimination. To help us monitor our equal opportunities policies, would you please provide the information requested below. The information will be treated in the strictest of confidence and will only be used to monitor our ability to provide services to all sectors of the community. Ethnic Group (Please tick one box only): White Asian or Asian British British (including Scottish and Welsh) Indian Indian British Irish Pakistani Pakistani British Gypsy Bangladeshi Bangladeshi British Travellers Other White background (please specify) Other Asian background (please specify) ………………………………………………. ……………………………………………… Mixed Black or Black British White & Black Caribbean Caribbean Caribbean British White & Black African African African British White & Asian Other mixed background (please specify) Other Black background (please specify) Chinese Japanese Other (please specify) Gender Physical Disability Mental Disability Learning Male Female Difficulty Transgender Do Yes No Yes No Yes No not wish to disclose First language Sexual Orientation English Lesbian Bi Sexual Other (please specify) Gay Do not wish to disclose … Translator required Heterosexual (straight) Age Religion 16 -17 18 25 Christian Jewish – 26 35 36 - 45 Muslim Buddhist – 46 55 56 - 65 Hindu Sikh – 66 + Atheist No Religion Do not wish to disclose
We are committed to eliminating discrimination. To help us monitor our equal opportunities policies, would you please provide the information requested below. The information will be treated in the strictest of confidence and will only be used to monitor our ability to provide services to all sectors of the community. Ethnic Group (Please tick one box only): White Asian or Asian British British (including Scottish and Welsh) Indian Indian British Irish Pakistani Pakistani British Gypsy Bangladeshi Bangladeshi British Travellers Other White background (please specify) Other Asian background (please specify) ………………………………………………. ……………………………………………… Mixed Black or Black British White & Black Caribbean Caribbean Caribbean British White & Black African African African British White & Asian Other mixed background (please specify) Other Black background (please specify) Chinese Japanese Other (please specify) Gender Male Female Transgender Do not wish to disclose Physical Disability Yes No Mental Disability Yes No Learning Difficulty Yes No First language English Other (please specify) … Translator required Sexual Orientation Lesbian Bi Sexual Gay Do not wish to disclose Heterosexual (straight) Age 16 -17 18 – 25 26 – 35 36 - 45 46 – 55 56 - 65 66 + Religion Christian Jewish Muslim Buddhist Hindu Sikh Atheist No Religion Do not wish to disclose