New Horizons Equality & Diversity Monitoring Form

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1. PERSONAL INFORMATION

PERSONAL INFORMATION   Male

Female

2. Marital status

Marital status   Single Divorced

Married Widowed

Separated

3. What is your age?

What is your age?

4. SEXUAL ORIENTATION

SEXUAL ORIENTATION   Heterosexual Lesbian

Gay Bisexual

Question refused

5. RELIGIOUS BELIEF
In the most recent UK Census the following religions were listed. Please place a tick in the box which most describes your religion, or add details of your religion if not listed below

RELIGIOUS BELIEF In the most recent UK Census the following religions were listed. Please place a tick in the box which most describes your religion, or add details of your religion if not listed below   Christian Buddhist Hindu

Jewish Muslim Sikh

No religion Question refused

6. ETHNIC ORIGIN
White

	British	Irish	White and Black Caribbean	White and Black African	White and Asian	Indian	Pakistani	Bangladeshi	Caribbean	African	Chinese
White	*ETHNIC ORIGIN White White British	White Irish	White White and Black Caribbean	White White and Black African	White White and Asian	White Indian	White Pakistani	White Bangladeshi	White Caribbean	White African	White Chinese
Mixed Asian	Mixed Asian British	Mixed Asian Irish	Mixed Asian White and Black Caribbean	Mixed Asian White and Black African	Mixed Asian White and Asian	Mixed Asian Indian	Mixed Asian Pakistani	Mixed Asian Bangladeshi	Mixed Asian Caribbean	Mixed Asian African	Mixed Asian Chinese
Black	Black British	Black Irish	Black White and Black Caribbean	Black White and Black African	Black White and Asian	Black Indian	Black Pakistani	Black Bangladeshi	Black Caribbean	Black African	Black Chinese
Chinese	Chinese British	Chinese Irish	Chinese White and Black Caribbean	Chinese White and Black African	Chinese White and Asian	Chinese Indian	Chinese Pakistani	Chinese Bangladeshi	Chinese Caribbean	Chinese African	Chinese Chinese
Other	Other British	Other Irish	Other White and Black Caribbean	Other White and Black African	Other White and Asian	Other Indian	Other Pakistani	Other Bangladeshi	Other Caribbean	Other African	Other Chinese

Other (please specify)