Equal Opportunities Form

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Facilitator for TALK

Email Address *

Where did you see the position advertised? *

Kill The Cat Email

Social Media

Other:

Please identify your gender *

Female (including male to female trans women)

Male (including female to male trans men)

Non-Binary

Prefer not to say

Other:

Gender Identity *

My gender identity is different to the sex it was assumed to be at birth

My gender identity is the sex that I was assumed to be at birth

Prefer not to say

Sexual Orientation *

Bisexual

Gay man

Gay woman / lesbian

Heterosexual

Queer

Pansexual

Prefer not to say

Other:

Which category below includes your age? *

0 - 19

20 - 34

35 - 49

50 - 64

65+

Prefer not to say

Please tick the ethnic category that best represents you. Your ethnic category is a mixture of culture, religion, skin colour, language and the origins of yourself and your family. It is not the same as nationality. *

English/Welsh/Scottish/Northern Irish/British

Irish

Gypsy or Irish Traveller

Any other White background

White and Black Caribbean

White and Black African

White and Asian

Any other Mixed/Multiple ethnic background

Indian

Pakistani

Bangladeshi

Chinese

Any other Asian background

African

Caribbean

Any other Black/African/Caribbean

Arab

Any other Ethnic group

Prefer not to say

Not Known

Other:

Disability *

Non-disabled

Identify as a deaf or disabled person, or have a long term health condition

Neurodiverse

Prefer not to say

Other:

Comment

Are you registered as a disabled person? *

Yes

Prefer not to say

Comment

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