Ethnicity Survey

Thank You!

Your submission has been received. But before you go please complete the form below.
Equality and diversity monitoring form

Filling in this form is voluntary and will not affect the outcome of the application. The information provided will be kept confidential and separate from the application and will only be used for equality monitoring purposes. If you are completing the form on behalf of someone else, please complete the form with their details
Origin Fund
Gender:*

FemaleIntersexMaleNon-binaryPrefer not to sayAdd your own
Is the gender you identify with the same as your gender registered at birth?*

YesNoPrefer not to say
Age group*

18 - 2425 - 2930 - 3435 - 3940 - 4445 - 4950 - 5455 - 5960 - 6465+Prefer not to say
Ethnic origin is not about nationality, place of birth or citizenship. It is about the group to which you perceive you belong. Please select from the following options or add your own.
What is your ethnicity*

AfricanArabBangladeshiBritishEnglishCaribbeanChineseIndianIrishNorthern IrishPakistaniScottishWelshWhite & AsianWhite & Black CaribbeanWhite & Black AfricanPrefer not to sayAdd your own
Do you consider yourself to have a disability or health condition?*

YesNoPrefer not to say
What is your sexual orientation*

AsexualBisexualHeterosexualHomosexualPansexualUndecidedPrefer not to sayAdd your own
What is your religion or belief*

AgnosticBuddhistChristianHinduJewishMuslimSikhPrefer not to sayAdd your own
Are you or anyone in your household in paid work?*

YesNoPrefer not to say
Do you have caring responsibilities?*

YesNoPrefer not to say

Should be Empty:

	Yes
Primary carer of child/children (under 18)
Primary carer of disabled child/children (under 18)
Primary carer of disabled adult (over 18)
Primary carer of older person
Secondary carer ( another person carries out the main caring role)

Thank You!