Ethnic Monitoring Proforma

ETHNIC MONITORING PROFORMA

MODEL EXAMPLE

By Slough Race Equality Council: March 2004, updated March 2006

MODEL EXPLANATIONS OF ETHNIC RECORD KEEPING:

The applicant or service user should be informed as to why they should give their personal information. Some or all of the following points can be used (or amended to fit the purpose of the monitoring) at the top of the monitoring form as appropriate to the purpose of the monitoring, to inform the applicant/service user of why monitoring is necessary.

NOTES ABOUT GIVING YOUR PERSONAL DETAILS:

v  This organisation is committed to developing positive policies to promote equal opportunities and eliminate discrimination in employment and in delivering our services. We need to measure personal information like ethnicity and nationality to ensure this happens.

v  Please complete this form and return with the other information requested. This information is absolutely crucial to us in ensuring that you get a fair and equal treatment in your dealings with us in delivering our services or in our organisation’s processes and procedures.

v  Your decision, however to fill in the details, is completely at your discretion and we will, of course, fully understand should you choose not to and this will not disadvantage you in any way.

v  Your personal details will be removed from the monitoring data BEFORE any recruitment or selection process begins or any other personal assessment to ensure that no discrimination on any basis occurs. All panels or service delivery will be granted on the merits of your application or case alone.

v  (Insert organisation here) ______is committed to encouraging & involving people who are more disadvantaged and excluded and to be ensure all forms of discrimination are eliminated – these questions help us monitor how effective we are at this.

v  Questions relating to your age, gender, disability and racial/ ethnic origin are used for equal opportunities monitoring purposes only, in the pursuance of equality, fairness and elimination of discrimination.

v  Data Protection Act 1998: Information in this form will be used for monitoring purposes. Your project details may be recorded on a database which may be used to gather general information that may be made public, BUT individual details will not be made public without permission. If you would like to discuss this further, please contact the Director of Slough REC on tel 01753 691266.

v  Please contact us should you have any questions or for further details ______(INSERT NAME & ADDRESS & CONTACT OF EMPLOYER HERE)

/

What is your Racial / Ethnic / National Background or Identity?

Please Self Define Your Background / Identity:
Please also tick any appropriate box(s) below.
/

(a) Arab or Arab British

/ / / (e) Pacific & Pacific British / /
/

(please specify)

/ / / /
/ / / / Chinese / /
/

(b) Asian or Asian British

/ / / Japanese
/

Bangladeshi

/ / / Other Pacific or East-Asian
/ / / / (please specify)
/

Indian

/ /
/

Pakistani

/ / / (f) White
/

Sikh

/ / / British
/

Other Asian Background

/ / / English
/

(please specify)

/
/ Irish
(c) Black or Black British / / Scottish
Black African / Welsh
/

(please specify)

/
/ / / White Central & Eastern European
(please specify)
Black Caribbean
/

(please specify)

/
/ / / White Other
(please specify)
Any other Black background
(please specify)
(g) Other
/

(d) Mixed Background

/ / European
/

Asian & White

/ (please specify)
Black African & White / Gypsy/Rroma
Traveller of Irish Heritage
Black Caribbean & White / Jewish
Any other mixed background / Any Other Ethnic Group
(please specify) / (please specify)
(h) Religious Group / (i) Languages Spoken
(optional – please specify if you wish) / (optional – please specify if you wish)