Diversity Form

NAME

 

GENDER

 

DISABILITY

Please state if you have any long-term physical or mental condition that affects your ability to carry out day-to-day activities. (Advice can be obtained from the Disability Rights Commission 08457 622 633)

   

 

AGE

Please state your age and date of birth:



 

SEXUAL ORIENTATION

 

ETHNIC CATEGORY

The following categories are based on those used in the 2001 census as recommended by the CRE. Please note the ethnic questions are not about nationality, place of birth or citizenship. UK citizens can belong to any of the ethnic categories indicated.

Please tick the box below which best describes the ethnic category to which you belong:

White




     

Mixed




     

Asian or Asian British





     

Black or Black British




     

Chinese or Chinese British or other ethnic group