Associate Artist Applicant 22-25 Monitoring Form

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We are grateful for your time in supporting us with this. If you would prefer to complete this form over the phone, please call Esther Alcock, Programme Administrator on 01473 235581.

Email *

First Name

Surname

Date of Birth

YYYY

Gender Identity *

Female (including trans women)

Male (including trans men)

Non-Binary (e.g. androgyne)

Prefer not to say

Other:

Is your gender identity different to the sex you were assumed to be at birth?

Assumed sex is a label that you’re given at birth. Most people are assigned male or female, some may be described as intersex. Gender identity is a social, cultural and legal status. Examples include, male, female, non-binary, trans, and genderqueer. Example: If at birth your assumed sex was female but you identify your gender as non-binary, your gender identity is different to the assumed sex given at birth.

Yes

Clear selection

Postcode

Nationality

Is English your second/additional language?

Yes

Unsure

Clear selection

Country of Residence

continued...

Tick this box if you are a non-EU national

Clear selection

Living Circumstances

Living in Care

A Care Leaver

A Care Giver

None

Clear selection

DISABILITY

Do you consider yourself to have a disability? *

No known disability

Blind/serious visual impairment

Deaf/serious hearing impairment

Physical impairment or mobility issues

Mental Health condition

Long-standing illness or health condition, e.g. epilepsy

Two or more impairments and /or medical conditions

Social/communication impairment, e.g. Autistic Spectrum Disorder

A specific learning difficulty, e.g. dyslexia

A disability, impairment or medical not listed

I do not wish to give this information

Other:

Required

ETHNICITY

Click on link for further explanation of ethnicity data:
https://www.ethnicity-facts-figures.service.gov.uk/ethnic-groups

WHITE

English / Welsh / Scottish / Northern Irish / British

Irish

Gypsy or Irish Traveller

Any other White background

Clear selection

MIXED / MULTIPLE ETHNIC GROUPS

White and Black Caribbean

White and Black African

White and Asian

Any other Mixed / Multiple ethnic background

Clear selection

ASIAN / ASIAN BRITISH

Indian

Pakistani

Bangladeshi

Chinese

Any other Asian background

Clear selection

BLACK / AFRICAN / CARIBBEAN / BLACK BRITISH

African

Caribbean

Any other Black / African / Caribbean background

Clear selection

OTHER ETHINC GROUP

Arab

Any other ethnic group

Clear selection

NON-SPECIFIED

Prefer not to say

Not known

Clear selection

SEXUAL ORIENTATION

https://lgbt.foundation/ https://www.stonewall.org.uk/

Sexual Orientation

Bisexual

Gay Man

Gay Woman (or lesbian)

Heterosexual (or straight)

Queer (or none of the above)

Prefer not to say

Other:

Clear selection

Religion or belief:

No religion

Buddhist

Christian

Hindu

Jewish

Muslim

Sikh

I prefer not to say

Other:

Clear selection

Send me a copy of my responses.

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