Equal Opportunities Monitoring Form s1

Trinity Specialist College

EQUAL OPPORTUNITIES MONITORING FORM

We are committed to ensuring that all job and volunteer applicants, workers, associates and students are treated equally and not discriminated against on the grounds of gender, sexual orientation, marital or civil partner status, gender reassignment, race, colour, nationality, ethnic or national origin, religion or belief, disability or age. You are not obliged to answer all the questions but the more information you supply, the more effective our monitoring will be. All information supplied will be treated in the strictest confidence. Thank you for your assistance.

Name:………………......

How would you describe your nationality and/or ethnicity (please tick)?

White: Mixed race: Asian or Asian British:

British - English, White and Black Indian Scottish or Welsh Caribbean

Irish White and Black Pakistani African

Any other White White and Asian Bangladeshi background

Any other Mixed Any other Asian background background

Black or Black Chinese or other British: ethnic group:

Caribbean Chinese

African Other ethnic group

Any other Black background

Is your age between (please tick):

16-24 25-29 30-39

40-49 50-59 60 or over

1 How would you describe your sexual orientation (please tick)?

Heterosexual Bisexual Lesbian

Gay Prefer not to Transgender/tra say nssexual

How would you describe your religion?

My religion is: ......

Prefer not to say

I am not religious

The Disability Discrimination Act 1995 (DDA) defines a disability as a "physical or mental impairment which has a substantial and long-term adverse effect on a person's ability to carry out normal day-to-day activities". An effect is long-term if it has lasted, or is likely to last, over 12 months. Do you consider yourself to have a disability under the DDA (please tick)?

Yes No

Prefer not to say Don't know

Where did you hear about this job/volunteer opportunity (please tick)?

Newspaper (please Friend Other (please specify which one) specify) ………......