Equality and diversity monitoring form

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All questions are optional and will be used to help compile anonymised equality and diversity reports.

How would you describe your gender?

If you would prefer not to answer, please skip this question

Female

Male

Non-binary

Other:

Clear selection

What gender were you assigned at birth?

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Female

Male

Other:

Clear selection

How would you describe your sexuality?

Bisexual or Pansexual

Gay

Straight

Other:

Clear selection

How would you describe your ethnic group?

Arab / Arab British

Asian / Asian British - Bangladeshi

Asian / Asian British - Indian

Asian / Asian British - Pakistani

Asian / Asian British - Chinese

Asian / Asian British - Other

Black / Black British - African

Black / Black British - Caribbean

Black / Black British - Other

Mixed - White and Black African

Mixed - White and Black Caribbean

Mixed - Other

White - English/Welsh/Scottish/Northern Irish/British

White - Irish

White - Gypsy or Irish Traveller

White - Other

Other:

Clear selection

If you chose 'Asian - Other', 'Black - Other', 'Mixed-Other' or 'White - Other', please describe your ethnic group

Do you have an impairment, health condition or learning difference?

Tick all that apply. If you would prefer not to answer, please skip this question. If there is anything YiS could do to better support you, please leave a comment on the last page of this form.

Yes, a physical impairment

Yes, an ongoing health condition

Yes, a learning difference

Information about ethnicity, gender identity, sexuality and your health are considered sensitive personal data under the Data Protection Act. Please indicate if you give us permission to store this information and use in a non-identifiable way.

Yes

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This form was created inside of YiS Young People's Mental Health. Report Abuse

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