EQUAL OPPORTUNITIES MONITORING FORM
To check on the effectiveness of our Equal Opportunities Policy, we record the age,
gender, sexual orientation, racial origin, martial status, religion and any disability of all
staff and members. To enable us to do this, we should be grateful if you would give
the details about yourself which are requested below.
The information that you provide will be kept secure.
Name:
1. Age?
Date of birth:
2. Gender? Please () one box
Male
Transgender Male
Female
Transgender Female
Prefer not to say
3. Marital Status? Please () one box
Single
Divorced
Separated
Married
Living with Partner
Widowed
Prefer not to say
4. Do you consider yourself to be …? Please () one box
Hetrosexual/straight
Bi-sexual
Gay Man
Prefer not to say
Gay Woman/lesbian
Other – please write in:
5. Do you consider yourself to be a gypsy/settled traveller? Please () one box
Yes
Prefer not to say
No
PLEASE TURN OVER
EQUAL OPPORTUNITIES FORM
6. To which of these groups do you consider you belong? Please () one box
White: British
Asian or Asian British: Indian
White: Irish
Asian or Asian British: Pakistani
White: Eastern European
Asian or Asian British: Bangladeshi
White: Western European
Any other Asian background
(not British/Irish)
(please tick and write in)
Any other White background
(please tick and write in)
Mixed: White and Black Caribbean
Black or Black British: Caribbean
Mixed: White and Black African
Black or Black British: African
Mixed: White and Asian
Any other Black background:
(please tick and write in)
Any other Mixed background
(please tick and write in)
Chinese
Other
(please tick and write in)
Prefer not to say
7. Do you have any longstanding illness, disability or infirmity? Please () one box
(physical or mental impairment which has a substantial and long-term adverse effect on your
ability to carry out normal day-to-day activities.)
Yes
If yes please give details:
No
Prefer not to say
8. Religion? Please () one box
Christianity
Islam
Hinduism
Sikhism
Judaism
Buddhism
Jainism
Atheism
Prefer not to say
Not Religious
Other – please write in:
PLEASE RETURN THIS FORM TO
Marty McAuley – Governance Lead
Teign Housing, Templar House, Collett Way, Newton Abbot, Devon TQ12 4PH
or email [email protected]
EQUAL OPPORTUNITIES FORM