Equality Monitoring Form

Equality Monitoring Form At UK Deaf Sport we want to make sure that people from all backgrounds benefit from the work we do, we also want to deliver our service in a way that works for you. If you complete this form and tell us a bit more about yourself, it will help us to improve the future planning of our services.

All data gathered is confidential to UK Deaf Sport and we will not be able to identify individuals from your response. Completion of this form is optional – you may wish to answer all or just some of the questions.

Gender Ethnic Monitoring ☐Male ☐Female ☐Prefer not to say White Age ☐Welsh/English/Scottish/North Irish/British ☐16-24 ☐25-34 ☐35-44 ☐Irish ☐45-54 ☐55-64 ☐65+ ☐Other White background (please specify) ☐Prefer not to say ______

Disability Mixed/Multiple Ethnic Groups Identifying as a disabled person can include ☐White & Black Caribbean people with hearing or sight impairments, ☐White & Black African mental health difficulties or learning difficulties, ☐White & Asian mobility impairments, or long term health ☐ conditions, for example, depression, diabetes, Other mixed/background multiple ethnic asthma, multiple sclerosis, HIV or cancer. (please specify) ______Do you identify yourself as a disabled person? ☐Yes (please specify) Asian/Asian British ______☐Indian ☐Pakistani ☐No ☐Prefer not to say ☐Bangladeshi ☐Chinese ☐Any other Asian (please specify) ______

Sexual orientation Black/African/Caribbean/Black British ☐Gay man ☐Gay woman/lesbian ☐African ☐Caribbean ☐Any ☐Heterosexual/straight ☐Bisexual ☐Other Black/African/Caribbean background ☐Other ☐Prefer not to say (please specify) ______Language and Communication What is your first language? Other Ethnic group ☐Arab ☐Gypsy or Irish Traveller ______☐Any other ethnic group (please specify) ______Please tell us whether you sign/speak, read, Religion/belief/non-belief write, understand or are learning BSL and Do you regard yourself as belonging to any English particular religion? British Sign Language (BSL) ☐Christian ☐Buddhist ☐Hindu ☐Sign ☐Understand ☐Learning ☐Muslim ☐Sikh ☐Jewish English ☐Other (please specify)______☐ ☐ ☐ Read Write Speak ☐No, no religion Version 2 – September 2015 Reviewed September 2016 UKDS Equality Monitoring Form Page 1 of 2 ☐Understand ☐Learning ☐Prefer not to say

Version 2 – September 2015 Reviewed September 2016 UKDS Equality Monitoring Form Page 2 of 2