Green Shoes Arts - Equal Opportunities and Data Monitoring

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THIS FORM IS NOT PART OF THE SELECTION PROCESS
(The information you provide will be treated in the strictest of confidence
and will not be seen by the selection panel)

Date of Birth *

YYYY

Gender *

Ethnicity *

Asian/Asian British Bangladeshi

Asian/Asian British Indian

Asian/Asian British Pakistani

Any Other Asian/Asian British Background

Black / Black British African

Black / Black British Carribean

Any Other Black/Black British background

Chinese

Mixed White & Black Caribbean

Mixed White & Black African

Mixed White & Asian

Mixed Other

Traveller, Romany or English Gypsy - Irish Traveller

Traveller, Romany or English Gypsy - Romany

Traveller, Romany or English Gypsy - English Gypsy

White British

White Irish

Any Other white background

Other Ethnic Group

Prefer not to say

Sexual Orientation *

Heterosexual

Homosexual

Bisexual

Prefer Not to Say

Other:

What is your faith? *

Christian

Muslim

Sikh

Hindu

Jewish

Buddhist

Atheist

Prefer Not to Say

None

Other:

Do you consider yourself to have a disability or health condition? *

Visual Impairment

Speech Impairment

Hearing Impairment

Other impairment

Wheelchair User

Restricted Mobility

Mental Health Issues

Learning Disability

Dyslexia

Dyspraxia

Other Learning difficulty

None

Other:

Required

Thank you

Data Protection Statement:
GSA (Green Shoes Arts) will use this information for monitoring and reporting purposes. We collect data on a secure server, where we keep it on file for 25 years, after 10 years we will suppress your data. If you wish to be removed from our database, you can email us at admin@greenshoesarts.com or send it in writing to Green Shoes Arts, CHCC, 255 High Road, Chadwell Heath, RM6 6AS

We will never sell your data to a third party.

Thank you for completing this form.

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