Equality and Diversity Form
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Equality and Diversity Form Age 16-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65+ Prefer not to say What is your ethnicity? Ethnic origin categories are not about nationality, place of birth or citizenship. They are about the group to which you as an individual perceive you belong. Please indicate your ethnic origin by ticking the appropriate box below Asian/Asian British Indian Pakistani Chinese Bangladeshi Any other Asian background Black/African/Caribbean/Black British African Caribbean Any other Black/African/Caribbean background Mixed/multiple ethnic groups White and Black Caribbean White and Black African White and Asian Any other mixed background White English Welsh Scottish Irish Gypsy or Irish Traveller Northern Irish Other White background Other ethnic group Arab Any other ethnic group Prefer not to say Please describe your gender identity Female (including male to female trans women) Male (including female to male trans men) Other Prefer not to say Is your gender identity different to the sex you were assumed to be at birth? Yes No Prefer not to say Pregnancy and maternity – as a woman, are you pregnant, on maternity leave or returning from maternity leave Yes No Prefer not to say Do you consider yourself to be Deaf or disabled? Section 6(1) of the Equality Act 2010 states that a person has a disability if: (a) That person has a physical or mental impairment, and (b) The impairment has a substantial and long-term adverse effect on that person’s ability to carry out normal day-to-day activities. Yes No Prefer not to say If yes, please tick all that apply Deaf Hard of hearing Learning difficulties Manual dexterity difficulties Mobility difficulties Blind/partially sighted Speech difficulty Mental health problems Facial disfigurement Progressive medical condition Long-term illness/medical condition Prefer not to say What is your sexual orientation? Heterosexual/straight Gay woman/lesbian Gay man Bisexual Questioning/undecided Other Prefer not to say What is your religion or belief? No religion Buddhist Christian Hindu Jewish Muslim Sikh Rastafarianism Any other religion Atheism Non-religious philosophy/belief-based lifestyle choices No beliefs Prefer not to say Did any of your parent(s) or guardian(s) complete a university degree course or equivalent (e.g., BA, BSc or higher)? Yes No I don’t know Prefer not to say What type of school did you mainly attend between the ages of 11 and 16? A non-selective state-run or state-funded school A selective (on academic, faith or other ground) state-run or state-funded school Independent or fee-paying school Attended school outside the UK I don’t know Prefer not to say Which of the following qualifications do you hold to date? (tick all that apply) 1-4 O levels/CSEs/GCSEs (any grades), Entry Level, Foundation Diploma NVQ Level 1, Foundation GNVQ, Basic Skills 5 or more O level passes/CSEs (grade 1)/GCSEs (grades A* to C), School Certificate, 1 A level/ 2-3 AS levels/VCEs, Higher Diploma NVQ Level 2, Intermediate GNVQ, City and Guilds Craft, BTEC First/General Diploma, RSA Diploma Apprenticeship 2 or more A levels/VCEs, 4or more AS levels, Higher School Certificate, Progression/Advanced Diploma NVQ Level 3, Advanced GNVQ, City and Guilds advanced craft, ONC, OND, BTEC National RSA Advanced Diploma Undergraduate degree (e.g., BA, BSc) Master’s degree (e.g., MA, MSc) Doctorate degree (e.g., PhD) NVQ level 4-5, HNC, HND, RSA Higher Diploma, BTEC Higher Level Professional qualifications (e.g. teaching, nursing, accountancy) Other vocational/work-related qualifications Non-UK qualifications No qualifications Prefer not to say Did either (or both) of the following apply at any point during your school years? Your household received income support Yes No I don’t know Prefer not to say You received free school meals Yes No I don’t know Prefer not to say What is your current working pattern? Full-time Part-time Prefer not to say Are you married or in a civil partnership? Yes No Prefer not to say What is your flexible working arrangement? (tick all that apply) None Homeworking Compressed hours Staggered hours Flexi-time Other Annualised hours Term-time hours Prefer not to say Flexible shifts Job share Do you have caring responsibilities? If yes tick all that apply None Primary carer for a child/children (under 18) Primary carer for disabled child/children (under 18) Primary carer for disabled adult (18 and over) Primary carer for an older person (65+) Secondary carer Prefer not to say Thank you for completing this form
