MONITORING INFORMATION NHS England and Health Education East Midlands are committed to a policy of equal opportunities. In order to monitor the effectiveness of this policy, applicants are asked to complete this monitoring form. These statistics are used solely for the purpose of monitoring and form no part of the selection procedure. The monitoring form will be separated from your application. Please tick the box which you feel describes your ethic origin. White British – White Irish – Other White Background Black or Black British Caribbean – Black or Black British African – Black Background Asian or Asian British Indian – Asian or Asian British Pakistani – or Asian British Bangladeshi – Chinese or Other Ethnic Background Chinese – Asian Background White and Black Caribbean – Mixed White and Black African – Mixed White and Asian – Mixed Background Other Ethnic Background Not Known Information Refused TO BE COMPLETED BY ALL APPLICANTS DISABILITY/SPECIAL NEEDS Please tick the box next to the statement which is most appropriate to you. You do not have a disability nor are aware of any additional support requirements in study You have dyslexia You are blind/partially sighted You are deaf/have a hearing impairment You are a wheelchair user or have mobile difficulties You need personal care support
MONITORING INFORMATION NHS England and Health Education East Midlands are committed to a policy of equal opportunities. In order to monitor the effectiveness of this policy, applicants are asked to complete this monitoring form. These statistics are used solely for the purpose of monitoring and form no part of the selection procedure. The monitoring form will be separated from your application. Please tick the box which you feel describes your ethic origin. White – British White – Irish Other White Background Black or Black British – Caribbean Black or Black British – African Black Background Asian or Asian British – Indian Asian or Asian British – Pakistani or Asian British – Bangladeshi Chinese or Other Ethnic Background – Chinese Asian Background – White and Black Caribbean Mixed – White and Black African Mixed – White and Asian Mixed Background Other Ethnic Background Not Known Information Refused TO BE COMPLETED BY ALL APPLICANTS DISABILITY/SPECIAL NEEDS Please tick the box next to the statement which is most appropriate to you. You do not have a disability nor are aware of any additional support requirements in study You have dyslexia You are blind/partially sighted You are deaf/have a hearing impairment You are a wheelchair user or have mobile difficulties You need personal care support
Application%20Form%20-%20HEE-EM%20Clinical%20Scholar%20Silver%20Scientist%202016.docx