Gender: (Please Tick One Box) Male R Female R

The information on this monitoring form is required by the University of Bath to assist us to implement equalities and diversity policies within the organisation. Your personal details will be used for internal statistical purposes and for anonymised reporting to external organisations such as the Higher Education Funding Council. You will not be contacted as a result of any information supplied on this form. The form complies with the requirements of the Data Protection Act 1998. Information is also being collected as recommended in the Sex Discrimination Act 1976, The Disability Discrimination Act 1995, The Race Relations Act 1976 and as amended in 2000. This information will be treated in confidence.

Date of Birth: …………………………………

Gender: (Please tick one box) Male r Female r

Do you consider that you have a disability?

(Please tick one box) Yes r No r

The Disability Discrimination Act 1995 describes disability as ‘a physical or mental impairment that has a substantial and long-term effect on your ability to carry out normal day-to-day activities’.

I would describe my ethnic origin as being: (Please tick one box below)

White

English / Welsh / Scottish / Northern Irish / British r

Irish r

Gypsy or Irish Traveller r

Any Other White Background r

Mixed / Multiple Ethnic

White & Black Caribbean r

White & Black African r

White & Asian r

Any Other Mixed / Multiple Ethnic Background r

Asian or Asian British

Indian r

Bangladeshi r

Pakistani r

Chinese r

Any Other Asian Background r

Black / African / Caribbean / Black British

African r

Caribbean r

Any Other Black / African / Caribbean Background r

Other Ethnic Group

Arab r

Any Other Ethnic Group (please specify)......

These ethnic origin categories are taken from the 2011 census circulated by the Office for National Statistics.

The University of Bath is committed to Quality, Excellence, Equality and Diversity