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Go Succeed Equality Monitoring Form

The following questions are optional. 


By providing us with equality monitoring information you will help us to ensure we provide a fair service to all the people in the community. This information will be held anonymously and only used for the purpose of meeting our equality monitoring obligations. Read our Privacy Notice here. 

1.  

In which council area do you live?

* required
2.  

How old are you?

* required
3.  

What is your gender?

* required
The wording on this question has been asked in accordance with the funder UKSPF's requirements.
4.  

Disability

Are your day-to-day activities limited because of a health problem or disability which has lasted, or is expected to last, at least 12 months?  (Include problems related to old age)

* required
5.  

Do you have dependents or caring responsibilities for family members or other persons?

* required
6.  

If yes, who do you have caring responsibilities for? (Choose all that apply)

7.  

Ethnic Origin

Ethnic origin is not about nationality, place of birth or citizenship. It is about the group to which you perceive you belong. Please tick the appropriate box from the selection below:

* required
Select option
Select option
10.  

Finally, what is your sexual orientation?  (Select one only)