Confidential
Equality and Diversity Monitoring Form
In order to monitor the equality element of The UK Sports Association’s policies and practices
effectively, we ask that you complete a monitoring questionnaire.
Monitoring is recommended to eliminate all forms of discrimination and to influence the
development of future policies, programmes and practices. Completion of all questions within
this form is optional, but the more information we have, the more effectively we can operate and
assess our equality and diversity policies in practice.
All questions relate to the protected characteristics covered by present equality legislation – the
Equality Act 2010.
All information about an individual will be stored securely and anonymously. Reports will be
produced in a depersonalised and aggregated form and will not in any way identify individuals.
Please answer all questions as instructed. If you do not answer a question, your response will
be recorded as ‘prefer not to say’.
Please return your completed questionnaire with your application. On receipt, your monitoring
form will be separated from your application form and does not form part of the recruitment
process.
It is your choice whether you complete the monitoring form, but we hope that you will support
our monitoring and evaluation by completing and sending with your application.
Thank you for your co-operation.
UK Sports Association for People with Learning Disability
UK Sports Association
2E Leroy House
436 Essex Road,
London N1 3QP
Personal Details
Name (optional)
Position applied for
Gender
Male
Female
Age
Please tick the row that applies to you:
Under 18
18-25
26-44
45-64
65+
Race and Cultural Background
From the list that follows, please indicate how you prefer to describe your race. These are the
categories used in the 2011 Census. Choose one section from A to E by ticking the row that
applies to you. Then choose the relevant description under that option to indicate your cultural
background tick – tick the row that applies to you
A. White
British
English
Northern Irish
Scottish
Welsh
Irish
Gypsy or Irish Traveller
Any other white background (please
specify)
B. Mixed/multiple ethnic groups
White and Black Caribbean
White and Black African
White and Asian
Any other Mixed/multiple ethnic background
(please specify
C. Asian/Asian British
Indian
Pakistani
Bangladeshi
Chinese
Any other Asian background (please
specify)
E. Other ethnic group
Arab
Any other ethnic group (please
specify)
D. Black/African/Caribbean/Black British
African
Caribbean
Any other Black/African/Caribbean
background (please specify)
Disability
The Equality Act 2010 defines disability as: ‘a person has a disability if s/he has a physical or
mental impairment which has substantial and long-term adverse effect on their ability to carry
out normal day-to-day activities.’
Do you consider yourself to be a disabled person? (Please delete as appropriate)
YES/NO
If you consider yourself to be a disabled person, please tick all of the following options that
describes your disability
Deaf/hearing impairment
Learning disability
Visual impairment
Learning difficulty
Physical impairment
Other (please specify)
Sexual Orientation
Please tick the row that applies to you:
Heterosexual
Lesbian
Bisexual
Other (please specify)
Gay
Gender Re-assignment
Please answer both of the following questions:
Are you transsexual with acquired gender of male? (please delete as appropriate) YES/NO
Are you transsexual with acquired gender of female? (please delete as appropriate) YES/NO
Religion
Please tick the row that applies to you:
None
Buddhist
Jewish
Sikh
Christian (including Church of England, Catholic, Protestant)
Hindu
Muslim
Other (please specify)
Thank you for completing this form. Please return to [email protected] with
your application