2013-14 Equality Monitoring Form
Equal Opportunities Monitoring Form
**STRICTLY CONFIDENTIAL**
Archery GB embraces the spirit of all equalitylegislation and is committed to eradicating any form of unlawful discrimination. We will not tolerate unfair discrimination either directly or indirectly, on the grounds of: age, disability, gender reassignment, marriage and civil partnership, pregnancy and maternity, race, religion or belief, sex and sexual orientation (together the Equality Act 2010 Protected Characteristics), class or social background, parental status or political persuasion.
In order to ensure our policy is implemented effectively, we need to monitor its impact. Please complete the questions on this sheet. This information is confidential and will be stored securely. The information will be used solely for the purposes of monitoring the impact of our equality policy.
To complete this form, please mark X in the appropriate boxes to show your answer and provide written text, if required, where indicated. If completing electronically please click the box to display an X.
1. What is your age?
☐Under 18☐18 – 24☐25 – 34☐35 – 44
☐45 – 54☐ 55 – 64☐65 – 74☐75+
☐ Do not wish to disclose
2. Are you?
☐Male☐ Female☐ Do not wish to disclose
3. To which ethnic group do you consider yourself to belong?
Please choose the relevant category for you from A to E shown in the tables below and indicate your ethnic background by marking the appropriate box in the column below your chosen category.
A White / B Mixed/Multiple ethnic groups: / C Asian or Asian British☐British / ☐White & Black Caribbean / ☐Indian
☐English / ☐White & Black African / ☐Pakistani
☐Northern Irish / ☐White & Asian / ☐Bangladeshi
☐Scottish / ☐Other (please specify)
…………………….…… / ☐Chinese
☐Welsh / ☐Other (please specify)
…………………….……
☐Irish / D Black/ African/ Caribbean/ Black British: / E Other ethnic group:
☐Gypsy or Irish Traveller / ☐African / ☐Arab
Other (please specify
…………………….… / ☐Caribbean / ☐Other (please specify)
…………………….……
☐Other (please specify)
…………………….…… / ☐F Do not wish to disclose
PTO
Document Reference: ED2015
4. What is your religion?
☐None / ☐Hindu / ☐Sikh☐Christian (including Church of England, Catholic, Protestant and all other Christian denominations) / ☐Jewish / ☐Other (please specify) ………………………….…
☐Buddhist / ☐Muslim / ☐Do not wish to disclose
5a. Do you consider yourself to have a disability?
The Equality Act 2010 defines disability as “a person has a disability if s/he has a physical or mental impairment which has a substantial and long-term adverse effect on their ability to carry out normal day-to-day activities.”
☐Yes / ☐No / ☐Do not wish to disclose5b. If you have indicated yes, please mark all the boxes that apply to you:
☐Visual impairment / ☐Learning disability/difficulty☐Hearing impairment / ☐Other (please specify)
……………………………………………
☐Physical impairment / ☐Do not wish to disclose
6. What is your Sexual Orientation?
☐Heterosexual / ☐Bisexual☐Lesbian / ☐Other (please specify)
……………………………………………
☐Gay / ☐Do not wish to disclose
7. If you have undergone, are undergoing or intend to undergo Gender Reassignment are you?
☐Transsexual with an acquired gender of male☐Transsexual with an acquired gender of female
☐Do not wish to disclose
☐Not Applicable
8. Are you?
☐Archery GB Coach / / ☐Archery GB Judge / ☐Do not wish to disclose
PLEASE RETURN COMPLETED FORMS TO:
ARCHERYGB, EQUALITY DATA, LILLESHALL NATIONAL SPORTS CENTRE, NEWPORT,SHROPSHIRE, TF10 9AT
Archery GB is the trading name of the Grand National Archery Society, a company limited byguarantee no. 1342150 Registered in England.