Equal Opportunities Monitoring Form

The Actors Centre operates selection policies designed to ensure that all applicants are treated equally regardless of age, gender, marital status, sexual orientation, disability, ethnic or national origin and is opposed to discrimination on any grounds. All applications are assessed in respect to the initiative/role/project being applied for. In accordance with the Codes of Practice of the Commission for Racial Equality and the Equal Opportunities Commission we monitor the effectiveness of our equal opportunities policies, and therefore ask all applicants to provide the following details.

Note: The information you provide is for monitoring purposes only; it will not form part of any selection process.

1. / Name / (Optional)
2. / Age / 15 and under o / 16-20 o / 21-29 o / 30-39 o
40-49 o / 50-59 o / 60 and over o / Rather not say o
3. / Which Gender do you Identify as? / Male o / Female o / Rather not say o
4. / Sexual Orientation / Asexual o / Bisexual o / Heterosexual o / Homosexual o
Other o Any details: / Rather not say o
5. / Nationality / 6. / Place of Birth
7. / Ethnic Origin

Please state your ethnic origin below (tick one box only). This does not mean your nationality or place of birth, but ancestral origins or broad ethnic group. These categories are recommended by the Commission for Racial Equality.

A. Black or Black British / B. East Asian or Other Ethnic Group / C. South Asian or South Asian British
o / African (A1) / o / Chinese (B1) / o / Bangladeshi (C1)
o / Caribbean (A2) / o / Japanese (B2) / o / Pakistani (C2)
o / Other Black or Black British / o / Korean (B3) / o / Indian (C3)
Background (A3) / o / Other (B4) / o / Any other Asian background (C4)
Please write Below / Please write Below / Please write Below
D. White / E. Mixed
o / British (D1) / o / White and Black African (E1) / o / Rather not say (F1)
o / English (D2) / o / White and Black Caribbean (E2)
o / Irish (D3) / o / White and East Asian (E3)
o / Scottish (D4) / o / White and South Asian (E4)
o / Welsh (D5) / o / Other mixed background (E5)
o / Gypsy or Irish Traveller (D6) / Please write Below
o / Other white background (D7)
Please write Below
8. / Faith/Beliefs/Religion
o / Agnostic / o / Atheist/No Religion / o / Rather not say
o / Buddhist / o / Christian / o / Other
o / Hindu / o / Jewish / Please write below
o / Muslim / o / Sikh
9. / Accessibility
The Disability Discrimination Act defines disability as a physical or mental impairment which has a substantial and long term adverse effect on a person’s ability to carry out normal day-to-day activities.
Do you consider yourself to be disabled?
Yes o / No o / Rather not say o
Do you have any learning assistance/disability needs?
Yes o / No o / Rather not say o
Would you describe yourself as someone who is experiencing or has experienced any mental health condition(s)?
Yes o / No o / Rather not say o
If you answered yes to any of the above, please advise us of the ways in which the Actor's Centre may be able to assist you with your access needs.

1A Tower Street, London, WC2H 9NP

T: 020 3841 6600

www.actorscentre.co.uk

The Actors Professional Centre Actors Workshops (London) Ltd

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