Equal Opportunities Monitoring Form

The information you give us will be treated in confidence and will be used by our Petitions team to provide statistics for equal opportunities monitoring to assess public engagement in the National Assembly for Wales’s petitions process. Please note all submissions are anonymous

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* 1. Gender

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* 2. Gender identity:
Do you identify as transgender?

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* 3. How would you describe your ethnic origin (please
tick the appropriate box)?

(These categories are those
used in the 2001 census and are recommended for
use by the former Commission for Racial
Equality).

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* 4. Please indicate your age group:

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* 5. The Disability Discrimination Act 1995 defines disability as a physical or mental impairment, which has a substantial and long-term adverse effect on a person’s ability to carry out day-to-day activities.

Do you have a disability?

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* 6. Tick all that apply:

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* 7. Which of the following religions, religious denominations or bodies do you currently belong to? If you do not belong to any of these please tick “none”:

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* 8. What is your sexual orientation?

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* 9. How did you hear about the petitions process?

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