PS² Equal Opportunities Monitoring Form

The purpose of this survey is to gather information to help us ensure we are reaching a diverse range of applicants, and that the wider society we serve is reflected in our programmes and team. Any information you provide will be treated as anonymous and will not be used in assessing your application or making any decisions which affect you directly. Data from these surveys will be processed by a PS² Board member and will only be retained until the process is completed. Please answer the following questions by ticking the appropriate box and/or providing details as required.


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1. Gender:
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2. Sexual Orientation:
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3. Age
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4. Highest education level attained (or in the process of attaining):

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5. Do you have caring responsibilities? If yes, please tick all that apply:
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5. Disability: 

Under the Disability Discrimination (NI) Act 1995 a disabled person is defined as a person with “a physical or mental impairment which has a substantial or long-term adverse effect on their ability to carry out a normal day’s activity.” Having read this definition, do you consider yourself to have a disability?

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PS² uses the social model of disability, which says that people are disabled by barriers in society, not by their impairment or difference. These barriers can be physical, like buildings which don’t have accessible toilets, or caused by social or cultural attitudes towards perceived difference. If you experience barriers, please describe what they are below, and what reasonable adjustments we can make to support your access. If this does not apply, please write N/A below.
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6. Religion:
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7. Cultural and ethnic background:


How would you describe your ethnic origin? Choose section A to F and then tick appropriate boxes to indicate your cultural background.


Untitled title
A. White
Clear selection
B. Mixed/dual heritage
Clear selection
C. West Asia / West Asian British / West Asian English / West Asian Irish / West Asian Scottish / West Asian Welsh
Clear selection
D. Asian / Asian British / Asian English / Asian Irish / Asian Scottish / Asian Welsh
Clear selection

E. Southeast Asian / Southeast  Asian British / Southeast  Asian English / Southeast  Asian Irish / 

Southeast Asian Scottish / Southeast  Asian Welsh

Clear selection
E. Black / Black British / Black English / Black Irish / Black Scottish / Black Welsh
Clear selection
F. East Asian 
Clear selection
G. Indigenous peoples
Clear selection
Thank you, we really value your responses. 
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