Equity, Diversity and Inclusion Form

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Dear (potential) member of staff or trustee,

To strengthen the equity, diversity and inclusion within our organisation, and to create an equitable, diverse, inclusive and fair work place, we would kindly ask you to fill in this form for our records.

All of your data from this self-disclosure form will be collected, stored and processed in accordance with The Girls' Network Data Protection Policy. Your unanonymised data will be used solely for internal purposes and will not be shared with third party.

Thank you very much in advance!

First name

Last name

Are you currently working for The Girls' Network (as a member of staff or trustee)? *

Yes

Position (or position applying for)

If you are applying for an opportunity: Where did you learn about the opportunity you are applying for?

Date of birth

YYYY

Which best describes your gender? *

Which best describes your sexual orientation? *

Do you consider yourself to live with a disability? *

Yes

Prefer not to say

Please feel free to include any additional information below.

Do you consider yourself to have a religion, if so which? *

No religion

Christian

Jewish

Muslim

Hindu

Sikh

Buddhist

Prefer not to say

Other:

Which best describes your ethnic identity? *

We have presented ethnicity options as shown on the UK census.

White (English/Welsh/Scottish/Northern Irish/British)

White (Irish)

White (Gypsy or Irish Traveller)

White (any other white background)

Mixed/multiple ethnic groups (White and Black Caribbean)

Mixed/multiple ethnic groups (White and Black African)

Mixed/multiple ethnic groups (White and Asian)

Mixed/multiple ethnic groups (any other mixed/multiple ethnic backgrounds)

Asian/Asian British (Indian)

Asian/Asian British (Pakistani)

Asian/Asian British (Bangladeshi)

Asian/Asian British (Chinese)

Asian/Asian British (any other Asian background)

Black/African/Caribbean/Black British (African)

Black/African/Caribbean/Black British (Caribbean)

Black/African/Caribbean/Black British (any other black/African/Caribbean backgrounds)

Hispanic

Middle Eastern/Middle Eastern British (Arab)

Middle Eastern/Middle Eastern British (any other Middle Eastern background)

I would prefer not to disclose.

Other:

What type of school did you attend between the ages 11 and 18? *

Were you eligible for Free School Meals at any point during your school career? *

Yes

I don't know

Prefer not to say

What is the highest level of qualification achieved by your parent/s guardian/s by the time you were 18? *

Post-graduate or higher (Masters, PhD, etc.)

Undergraduate or equivalent degree

Professional qualifications

A-Level/GCSE/BTEC/NVQ

No qualifications

I don't know

Prefer not to say

Other:

What is your current highest level of qualification? *

Post-graduate or higher (Masters, PhD, etc.)

Undergraduate or equivalent degree

Professional qualifications

A-Level/GCSE/BTEC/NVQ

No qualifications

I don't know

Prefer not to say

Other:

Submit

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