Equal opportunities monitoring form

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Please fill out this form to help us record who we are reaching with this R&D programme.

Filling in this form is voluntary. The information you provide is confidential and will not be shared with the panel.

Please complete the form as you feel is most appropriate for you.

What is your age? *

18-25

26-35

36-45

46-55

Over 56

Prefer not to say

How do you identify your gender? If you feel any other identity best describes you please choose 'other' *

Woman

Man

Non-binary

Prefer not to say

Prefer to self-describe

Other:

Is your gender identity different to the one assigned to you at birth? *

Same

Different

Prefer not to say

What is your sexual orientation? *

Prefer not to say

Asexual

Bisexual

Gay

Heterosexual

Lesbian

Queer

Pansexual

Other

What is your religion/ belief? *

Atheism

Agnosticism

Buddhism

Christianity

Hinduism

Islam

Judaism

Rastafarianism

Sikhism

Traditional African Religions

African Diaspora Religions

Indigenous American Religions

Prefer not to say

No religion

Other:

Do you have caring responsibilities? *

Primary carer of a child/children (under 18)

Primary carer of disabled child/children

Primary carer of disabled adult (18 and over)

Primary carer of older person

None

Required

Do you consider yourself to have a disability? *

Yes

Prefer not to say.

Required

If you answered 'yes' what is the nature of your disability? *

Blind/visual impairment

D/Deaf/Hearing impairment

Learning Difficulty

Mental Health

Mobility

Speech Impairment

Prefer not to say

Other:

What is your nationality? *

What is your ethnic origin? *

Prefer not to say

Asian or Asian British – Bangladeshi

Asian or Asian British – Indian

Asian or Asian British – Pakistani

Chinese

Other Asian background

Mixed – Asian & White

Mixed – Black African & White

Mixed – Black Caribbean & White

Black or Black British – African

Black or Black British – Caribbean

Other Black background

White – British

White – European

White – Other

Other

Did you receive free school meals at your time at school? *

Yes

Prefer not to say

Did you go to university? *

Yes

Prefer not to say

Thank you for taking the time to complete this form.

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