Equality and Diversity Monitoring form
Phizzical may use this information to report to our stakeholders who monitor the different backgrounds of people who engage in our activities. Our stakeholders require this information from organisations who receive grants to report back to the Government. We will not use this information to assess your application. 

If you do not know some of the information or you would prefer not to provide it, you can fill in the 'Not known/Prefer not to answer' box. 
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Your role *
Ethnicity *
Age *
Disability Status: The Equalities Act approached disability as a condition that could impact your ability to carry out normal day to day activities.  The DDA defines disability as a physical and mental impairment that has substantial and long term (more than 12 months) adverse effects on a person's ability to carry out normal day to day activities.  Such disability may be invisible to others.  Under this definition, would you say you have a disability? *
If you consider yourself to be disabled, please tick the options below that best describe your disability.
Gender identity *
Is your gender identity different to what which it was assumed to be at birth?
Clear selection
Sexual Orientation *
Submit
Clear form
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