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Equal Opportunity Monitoring Form
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11
Questions
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1
Gender
Please select the option that best describes your gender identity
Woman
Man
Non-Binary
Prefer not to say
Intersex
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2
Do you identify as Trans
Yes
No
Prefer not to say
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3
Are you married or in a civil partnership
Yes
No
Prefer not to say
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4
Age
0-19
20- 34
35 - 49
50- 64
65 +
Prefer not to say
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5
How would you describe your ethnicity?
We understand that identity is more personal and complex than a single tick box, so use this space to define your ethnicity as you see fit.
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6
Do you consider yourself to have a disability or long-term, chronic health condition/s?
Under the Equality Act 2010, a disability is described as
‘a physical or mental impairment that has a ‘substantial’ and ‘long-term’ negative effect on your ability to do normal daily activities’
.
Yes
No
Prefer not to say
Type option 4
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7
Sexual Orientation
Bisexual
Gay Man
Gay Woman/Lesbian
Queer
Heterosexual/Straight
Prefer not to say
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8
Religion
Buddhist
Christian
Hindu
Jewish
Muslim
No Religion
Sikh
Prefer not to say
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9
Caring Responsibilities
Please tick all that apply
None
Primary carer of a child/children under 18
Primary carer of a disabled child/children
Primary carer of a disabled adult (over 18)
Primary carer of an older person
Prefer not to say
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10
Socio-Economic Background
Please select the option that best describes the occupation of the
main/highest income earner
in your household
when you were aged 14
.
Clerical and intermediate occupations e.g secretary, personal assistant, nursery nurse
Middle or junior managers e.g office manager, warehouse manager, restaurant manager
Modern professional occupations e.g teacher, nurse, social worker, artist, musician
Routine manual and service occupations e.g van driver, cleaner, porter, waiter/waitress
Semi-routine manual and service occupations e.g postal worker, security guard, machine worker, receptionist, sales assistant
Senior managers and administrators e.g finance manager, chief executive
Technical and craft occupations e.g fitter, plumber, printer, electrician
Long-term unemployment e.g claimed jobseeker's allowance or earlier unemployment benefit for more than a year
Prefer not to say
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11
Socio-Economic Background - what type of school did you mainly attend between the ages of 11 and 16?
Attended school outside the UK
Independent or fee-paying school on bursary
Independent or fee-paying school without bursary
State-run or state funded school
Prefer not to say
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