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Manchester Disabled People's Access Group

Manchester Disabled People's Access Group

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Diversity Monitoring Form

1. Gender Identity

Which of the following describes how you think of yourself?
MaleFemaleIn another wayPrefer not to say

Is the current gender you identity with different to the gender you were described as at birth?
YesNoPrefer not to say

2. Disability

Do you consider yourself to be a disabled person?
YesNoPrefer not to say

3. Ethnic Background

UKIrishGypsy or TravellerAny other White background

Mixed/Multiple ethnic background
Mixed ethnic background

Asian/Asian UK
IndianPakistaniBangladeshiChineseAny other Asian background

Black/African/Caribbean/Black UK
AfricanCaribbeanAny other Black/African/Caribbean background

Other ethnic group
ArabAny other ethnic groupPrefer not to say

4. Age

18-25 years26-40 years41-50 years51-65 years66-80 years81 plusPrefer not to say

5. Religion and belief

No religionChristianBuddhistHinduJewishMuslimSikhOther religionPrefer not to say

6. Sexual Orientation

HeterosexualGayLesbianBisexualPrefer not to say

7. Caring Responsibilities

People with caring responsibilitiesPeople without caring responsibilitiesPrefer not to say

Your Name (Required)

Your Contact Number (Required)

Your Email (Required)

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