EMBASSY Equalities monitoring form

Request edit access

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

🗒️ EMBASSY seeks to ensure that all aspects of our work reflect diversity and support equality of opportunity. This information helps us to identify areas of under-representation among applicants, members and our wider community. This assists us in developing strategies to attract talented people from these groups, also ensuring there is no discrimination in the allocation of support and or opportunities. The information provided in this form is strictly confidential and will be kept separate from your application. Your answers here will not affect your application to any of our opportunities. 🗒️

What data Embassy Gallery keeps and why we keep this data: EMBASSY Data Protection Policy

If there are questions you’d rather not answer, please select "Prefer not to say" or skip to the next question.

Opportunity you are applying for

Committee Member Open Call

Board of Trustees Open Call

Members Fund Open Call

Emerging Strategies (Artist Development Programme) Open Call

Community Takeover application

Undertaking paid work with EMBASSY

Committee Member

Becoming a Member

Biscuit Tin selected artist

Solo show

Other

Clear selection

If you live in the UK what is your full Postcode

If you live outside the UK what is your country of residence

What Gender do you identify with

Male

Female

Non-binary

Gender fluid

Prefer not to say

Clear selection

Do you identify as transgender ?

yes

Preference not to say

Clear selection

What sexuality do you identify with

Bisexual

Gay Man

Gay Woman/Lesbian

Straight/Heterosexual

Queer

Asexual

Other

Prefer not to say

Clear selection

What age are you

Under 18

18-20

21-34

35-49

50-64

64+

prefer not to say

Clear selection

What is your ethnic group

White British

White Irish

White Gypsy or Traveler

Any other white background

Mixed White and Black Caribbean

Mixed White and Black African

Mixed white and Asian

Any other Mixed Background

Asian or Asian British Pakistani

Asian or Asian British Indian

Asian or Asian British Bangladeshi

Asian or Asian British Chinese

Any other Asian or British Asian

Black or Black British African

Black or Black British Caribbean

Any other Black or Black British

Arab

Any other ethnic group

Prefer not to say

Clear selection

Religion/Belief

Christian

Jewish

Muslim

Buddhist

Hindu

Sikh

Atheist

Other

Prefer not to say

Clear selection

Do you consider yourself to have a disability or impairment?

Yes

not sure

prefer not to say

Clear selection

If yes to the above please specify

Visual Impairment

Hearing impairment/Deaf

Speech impairment

Mobility Impairment

Physical disability

Cognitive or learning disability

Mental health condition

Other

prefer not to say

Current employment status

Self-employed

employed full-time

employed part-time

Unemployed

Student

Unable to work

Prefer not to say

Clear selection

If you went to university (to study BA or higher), were you part of the first generation of your family to do so.

Yes

Did not attend University

Prefer not to say

Clear selection

Did you mainly attend a state or a fee–paying school between the ages of 11 and 18

UK State School

UK Fee-paying independent School

Attended School outside the UK

Prefer not to say

Clear selection

If you attended a fee-paying school did you receive any kind of financial reward to cover 50% or more of the school fee?

yes

Clear selection

Have you ever experienced any of the following

Domestic violence (parental or direct)

Homelessness (parental or direct)

Addiction (parental or direct)

care-experienced, estranged (including kinship care)

time spent in prison (parental or direct)

Carer to someone with long-term physical or mental health disability

Psychiatric detainment (parental or direct)

Do yo have any thoughts on how we could make this form more accessible?

Submit

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report

Forms