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Learner’s Equality & Diversity Monitoring Form

LEARNER’S EQUALITY & DIVERSITY MONITORING FORM

Date

Gender

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

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

Age
16-20 21-26 27-34 35-44 45-55 Over 55

Asian or Asian British
Indian Pakistani Bangladeshi Chinese Prefer not to say

Any other Asian background, please write in:

Black, African, Caribbean or Black British
African Caribbean Prefer not to say

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

Mixed or Multiple ethnic group
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:

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 consider yourself to have a disability?
Yes No Prefer not to say

If Yes, please specify

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Please check the highlighted fields.

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