Standard equality monitoring questions
About you
What is your age group?
0 – 15 / 16 – 24 / 25 – 34 / 35 – 44 / 45 – 54 / 55 – 64 / 65+ / Prefer not to sayDo you consider yourself to be disabled?
Yes / No / Prefer not to sayUnder the Equality Act, you are disabled if you have a long-term physical or mental impairment which affects your ability to carry out day-to-day activities.
If you are disabled, what is the nature of your disability?
Learning or developmental disabilities (including dyslexia and autism)Long term illness (including cancer, diabetes, HIV and multiple sclerosis)
Mental health condition (including anxiety, bipolar disorder and depression)
Physical impairment (including arthritis, cerebral palsy and using a wheelchair)
Sensory impairment (including hearing, sight and speech impairments)
Other / Prefer not to say
What is your ethnicity?
Asian or Asian British:Bangladeshi / Chinese / Indian / Pakistani / Sri Lankan / Other
Black or Black British:
African / Caribbean / Somali / Other
Mixed background:
White and Asian / White and Black African / White and Black Caribbean / Other
White or White British:
British, English, Welsh, Scottish or Northern Irish / Eastern European / Gypsy, Roma or Traveller / Irish / Western European / Other
Other ethnic background:
Arab / Latin American / Other
Prefer not to say
What is your gender?
Female / Male / Prefer not to sayIs your gender identity different to the sex you were assumed to be at birth?
Yes, it’s different / No, it’s the same / Prefer not to sayAre you married or in a civil partnership?
Yes / No / Prefer not to sayWhat is your sexual orientation?
Bisexual / Gay man / Gay woman or lesbianHeterosexual or straight / Other / Prefer not to say
What is your religion or belief?
No religion or belief / Baha’i / BuddhistChristian / Hindu / Jain
Jewish / Muslim / Rastafarian
Sikh / Other / Prefer not to say
1