Equality & Diversity Monitoring Form

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Chrysalis Arts Development is a publicly funded organisation and is required to statistically analyse the demographics of our staff, freelancers and artists. This includes information on age, disability, ethnicity, gender and sexual orientation. The information you provide in the form below is anonymous for monitoring purposes only and does not form part of an application you make to us.

Please indicate your age group

0–19

20-34

35-49

50-64

65+

Prefer not to say

How would you describe your ethnicity?

Asian/Asian British – Bangladeshi

Asian/Asian British - Chinese

Asian/Asian British - Indian

Asian/Asian British - Pakistani

Asian/Asian British - Any other Asian background (please describe below)

Black/Black British - African

Black/Black British - Caribbean

Black/Black British - Any other Black, African or Caribbean background (please describe below)

Mixed or Multiple ethnic groups

Mixed - White and Black Caribbean

Mixed - White and Black African

Mixed - White and Asian

Mixed - Any other Mixed or Multiple ethnic background (please describe below)

White – British

White – Irish

White – Gypsy or Irish Traveller

White – Any other White background (please describe below)

If you selected an answer with please describe in the above question, please do so here:

Please indicate the disability related category that you feel best represents you:

Disabled person

Person with long term health condition

Person with access requirements

Non disabled/no health conditions/no access requirements

Prefer not to say

How would you describe your gender:

Male (including those identifying as male)

Female (including those identifying as female)

Non-binary

In another way (please describe)

Prefer not to say

Is your gender identity different to that which it was assumed to be at birth?

Yes

Prefer not to say

Please indicate the sexual orientation category that you feel best represents you:

Asexual

Bisexual

Gay

Heterosexual

Lesbian

Pansexual

Undecided

Prefer not to say

I identify differently to any of the given categories (please describe below)

If you selected an answer with please describe in the above question, please do so here:

Where did you see this opportunity advertised?

Data Protection

We ask for this information so we and our funders know about who our activities are reaching. All data collated is anonymised and we will not pass on individual details to anyone else. To read our Privacy Policy, visit www.chrysalisarts.com/privacy

Chrysalis Arts is the creator and organiser of our CPD sessions. The company is registered under the Data Protection Act 1998.

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