Equality and diversity monitoring form

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Green Croft Arts wants to meet the aims and commitments set out in its equality policy. This includes not discriminating under the Equality Act 2010, and building an accurate picture of the make-up of the workforce in encouraging equality and diversity.

We need your help and co-operation to enable it to do this, but filling in this form is voluntary. The information provided will be kept confidential and will be used for monitoring purposes.

If you have any questions about the form contact Amanda Drago on amanda@greencroftonthewall.com

Gender

Male

Female

Intersex

Non-binary

Prefer not to say

If you prefer to use your own gender identity, please write below

Is the gender you identify with the same as your gender registered at birth?

Yes

Prefer not to say

Age

16-24

25-29

30-34

35-39

40-44

45-49

50-54

55-59

60-64

65+

Prefer not to say

What is your ethnicity?

Ethnic origin is not about nationality, place of birth or citizenship. It is about the group to which you perceive you belong. Please tick the appropriate box.

Asian or Asian British

Indian

Pakistani

Bangladeshi

Chinese

Prefer not to say

Clear selection

Any other Asian background, please write in:

Black, African, Caribbean or Black British

African

Caribbean

Prefer not to say

Clear selection

Any other Black, African or Caribbean background, please write in:

Mixed or Multiple ethnic groups

White and Black Caribbean

White and Black African

White and Asian

Prefer not to say

Any other Mixed or Multiple ethnic background, please write in:

White

English

Welsh

Scottish

Northern Irish

Irish

British

Gypsy or Irish Traveller

Prefer not to say

Any other White background, please write in:

Other ethnic group

Arab

Prefer not to say

Any Other ethnic group, please write in:

Do you consider yourself to have a disability or health condition?

Yes

Prefer not to say

What is the effect or impact of your disability or health condition on your work? Please write in here:

(The information in this form is for monitoring purposes only. If you believe you need a ‘reasonable adjustment’ then please email Amanda Drago on the email above.)

What is your sexual orientation?

Heterosexual

Gay

Lesbian

Bisexual

Asexual

Pansexual

Undecided

Prefer not to say

If you prefer to use your own identity, please write in:

What is your religion or belief?

No religion or belief

Buddhist

Christian

Hindu

Jewish

Muslim

Sikh

Prefer not to say

If other religion or belief, please write in:

Do you have caring responsibilities? If yes, please tick all that apply

None

Primary carer of a child/children (under 18)

Primary carer of disabled child/children

Primary carer of disabled adult (18 and over)

Primary carer of older person

Secondary carer (another person carries out the main caring role)

Prefer not to say

Submit

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