Asian or Asian British: British - English, White and Black [ ] [ ] Indian [ ] Scottish or Welsh Caribbean White and Black Irish [ ] [ ] Pakistani [ ] African Other White [ ] White and Asian [ ] Bangladeshi [ ] background Other Mixed Other Asian [ ] [ ] background background D E Black or Black Chinese and other British: groups: Caribbean [ ] Chinese [ ] Prefer not to say [ ] African [ ] Other ethnic group [ ] Other Black [ ] background What is your age (please tick)? 16–17 [ ] 18–21 [ ] 22–30 [ ] 31–40 [ ] 41–50 [ ] [ ] Prefer not to 51–60 [ ] 61–65 [ ] 66–70 [ ] 71+ [ ] say How would you describe your sexual orientation (please tick)? Heterosexual / [ ] Bisexual [ ] Prefer not to say [ ] straight Gay woman / [ ] Gay man [ ] [ ] Other lesbian Please describe your religion or other strongly-held belief. I would describe my religion or belief as: ................................................. I have no particular religion or belief [ ] Prefer not to say [ ] The Equality Act 2010 defines a disability as a "physical or mental impairment which has a substantial and long-term adverse effect on a person's ability to carry out normal day-to-day activities". An effect is long-term if it has lasted, or is likely to last, more than 12 months. Do you consider that you have a disability under the Equality Act (please tick)? Yes [ ] No [ ] Used to have a disability but have [ ] Don't know [ ] now recovered Prefer not to say [ ]
Asian or Asian British: British - English, Scottish or Welsh [ ] White and Black Caribbean [ ] Indian [ ] Irish [ ] White and Black African [ ] Pakistani [ ] Other White background [ ] White and Asian [ ] Bangladeshi [ ] Other Mixed background [ ] Other Asian background [ ] D Black or Black British: E Chinese and other groups: Caribbean [ ] Chinese [ ] Prefer not to say [ ] African [ ] Other ethnic group [ ] Other Black background [ ] What is your age (please tick)? 16–17 [ ] 18–21 [ ] 22–30 [ ] 31–40 [ ] 41–50 [ ] 51–60 [ ] 61–65 [ ] 66–70 [ ] 71+ [ ] Prefer not to say [ ] How would you describe your sexual orientation (please tick)? Heterosexual / straight [ ] Bisexual [ ] Prefer not to say [ ] Gay man [ ] Gay woman / lesbian [ ] Other [ ] Please describe your religion or other strongly-held belief. I would describe my religion or belief as: ................................................. I have no particular religion or belief [ ] Prefer not to say [ ] The Equality Act 2010 defines a disability as a "physical or mental impairment which has a substantial and long-term adverse effect on a person's ability to carry out normal day-to-day activities". An effect is long-term if it has lasted, or is likely to last, more than 12 months. Do you consider that you have a disability under the Equality Act (please tick)? Yes [ ] No [ ] Used to have a disability but have now recovered [ ] Don't know [ ] Prefer not to say [ ]
Equal-Opportunities-Monitoring-Form.docx