Equal Opportunities Monitoring

To help us to be sure that we are reaching all sections of the community we would like you to provide some details about yourself which will not be disclosed. This information will be used for monitoring purposes only and will be treated in accordance with the Data Protection Act 1998.

Equal Opportunities Monitoring

1. Are you:

Female

Male

 

2. Which age group are you?

16-24

25-34

35-44

45-54

55-64

65+

 

3. Including yourself, how many adults aged 18 or over live in your household?

One

Two

Three

Four or more

4. Are there any children or young people aged 17 or under living full time in your household?

Yes

No

If 'No' go to Question 6

5. How many children are there in each of the following age groups in your household?

Children aged 0-9:

Children aged 10-15:

Children aged 16-17:

6. The Disability Discrimination Act 1995 defines disability as “a physical or mental impairment which has a substantial and long term (12 months) adverse effect on his or her ability to carry out normal day to day activities”. Would you describe yourself as having a long-term disability as defined above?

Yes

No

7. To which of these groups do you consider you belong?:

White British

White Irish

Any other White background

Mixed/White and Asian

Mixed/White and Black African

Mixed/White and Black Caribbean

Any other mixed background

Indian

Bangladeshi

Pakistani

Any other Asian background

Black African

Black British

Black Caribbean

Any other Black background

Chinese

Any other ethnic group (please specify below)