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Equality and diversity questionnaire
1.
Are you...
Male
Female
Prefer not to say
2.
Your age
24 or below
25-34
35-44
45-54
55-64
65- 74
75 or above
Prefer not to say
3.
Do you consider yourself to have a disability?
Yes
No
Don't Know / Prefer not to say
Disability
The Equality Act 2010 defines a person as having a disability if s/he 'has a long-term physical or mental impairment which has a substantial and long-term adverse effect on his/her ability to carry out normal day to day activities'.
4.
What is your religion?
Christian
Muslim
Hindu
Sikh
Buddhis
Jewish
No religion
Other
Prefer not to say
5.
What is your sexual orientation?
Bisexual
Gay man
Gay woman/ Lesbian
Heterosexual/ Straight
Other
Prefer not to say
6.
What is your marital status?
Married
Single
Separated
Divorced
Widowed
Other
Prefer not to say
7.
Are you currently pregnant or have given birth in the last 12 months?
Yes
No
Prefer not to say
8.
To which of these ethnic groups do you consider that you
belong?
White
English / Welsh / Scottish / Northern Irish / British
Irish
Gypsy / Irish Traveller
Any other White ethnic group
9.
Mixed / Multiple
White & Black Caribbean
White & Black African
White & Asian
Any other Mixed/Multiple ethnic group
10.
Asian / Asian British
Indian
Pakistani
Bangladeshi
Chinese
Any other Asian / Asian British ethnic group
11.
Black / Black British
African
Caribbean
Any other Black / Black British ethnic group
12.
Other
Arab
Any other Other ethnic group