CONFIDENTIAL

Volunteer Equal Opportunities

Monitoring Form

This section will be separated from your volunteer application form on receipt. Completing this section will not in any way affect the fair consideration of your application. The information we collect here is very useful to us as it helps us to make sure that we are an inclusive volunteer opportunities provider and to monitor the diversity of our volunteer workforce.We will treat thisinformation as strictly confidential and will not be stored with any identifying information about you. We positively encourage applications from suitably and eligible candidates regardless of age, disability, race, sex, gender reassignment, sexual orientation, religion or belief, marriage and civil partnership and caring status.
  1. Age

Please return your signed and completed form to Maria Galan| Volunteer Co-Ordinator

Email: |Housing for Women, 6th Floor, Blue Star House 234-244 Stockwell Road, London, SW9 9SP| 020 3794 4798 | 077 1146 9094

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16-17
18-21
22-30
31-40
41-50
51-60
61-65
65+
Prefer not to say

Please return your signed and completed form to Maria Galan| Volunteer Co-Ordinator

Email: |Housing for Women, 6th Floor, Blue Star House 234-244 Stockwell Road, London, SW9 9SP| 020 3794 4798 | 077 1146 9094

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  1. Disability

Do you consider yourself to have a disability?

Please return your signed and completed form to Maria Galan| Volunteer Co-Ordinator

Email: |Housing for Women, 6th Floor, Blue Star House 234-244 Stockwell Road, London, SW9 9SP| 020 3794 4798 | 077 1146 9094

CONFIDENTIAL

Yes
No
Prefer not to say

Please return your signed and completed form to Maria Galan| Volunteer Co-Ordinator

Email: |Housing for Women, 6th Floor, Blue Star House 234-244 Stockwell Road, London, SW9 9SP| 020 3794 4798 | 077 1146 9094

CONFIDENTIAL

  1. Your ethnic group (based on the Census 2011 categories and are listed alphabetically)

Please return your signed and completed form to Maria Galan| Volunteer Co-Ordinator

Email: |Housing for Women, 6th Floor, Blue Star House 234-244 Stockwell Road, London, SW9 9SP| 020 3794 4798 | 077 1146 9094

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Asian/ Asian British
Bangladeshi
Chinese
Indian
Pakistani
Any other Asian background
Specify if you wish
Black/ African/ Caribbean/ Black British
African
Caribbean
Black British
Any other Black background Specify if you wish
Mixed/ Multiple Ethnic Groups
White/Asian
White/Black Caribbean
White/Black African
Any other mixed background. Specify if you wish
Other Ethnic Group
Arab
Any other background
Specify if you wish
White
White British (English/ Welsh/ Scottish/Northern Irish)
Irish
Any other White background
Specify if you wish
Prefer not to say
Prefer not to say

Please return your signed and completed form to Maria Galan| Volunteer Co-Ordinator

Email: |Housing for Women, 6th Floor, Blue Star House 234-244 Stockwell Road, London, SW9 9SP| 020 3794 4798 | 077 1146 9094

CONFIDENTIAL

  1. Your Gender

Please return your signed and completed form to Maria Galan| Volunteer Co-Ordinator

Email: |Housing for Women, 6th Floor, Blue Star House 234-244 Stockwell Road, London, SW9 9SP| 020 3794 4798 | 077 1146 9094

CONFIDENTIAL

Female
Male
Prefer not to say

Please return your signed and completed form to Maria Galan| Volunteer Co-Ordinator

Email: |Housing for Women, 6th Floor, Blue Star House 234-244 Stockwell Road, London, SW9 9SP| 020 3794 4798 | 077 1146 9094

CONFIDENTIAL

4.a If you are undergoing gender re-assignment please tick the box that applies to your future gender

Is your gender as stated above the same as the one assigned to you at birth?

Please return your signed and completed form to Maria Galan| Volunteer Co-Ordinator

Email: |Housing for Women, 6th Floor, Blue Star House 234-244 Stockwell Road, London, SW9 9SP| 020 3794 4798 | 077 1146 9094

CONFIDENTIAL

Yes
No
Prefer not to say

Please return your signed and completed form to Maria Galan| Volunteer Co-Ordinator

Email: |Housing for Women, 6th Floor, Blue Star House 234-244 Stockwell Road, London, SW9 9SP| 020 3794 4798 | 077 1146 9094

CONFIDENTIAL

  1. Your Sexual Orientation (Which of the options best describes how you think about yourself?)

Please return your signed and completed form to Maria Galan| Volunteer Co-Ordinator

Email: |Housing for Women, 6th Floor, Blue Star House 234-244 Stockwell Road, London, SW9 9SP| 020 3794 4798 | 077 1146 9094

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Bisexual
Gay/lesbian
Heterosexual/
Straight
Other (specify if you wish)
Prefer not to say

Please return your signed and completed form to Maria Galan| Volunteer Co-Ordinator

Email: |Housing for Women, 6th Floor, Blue Star House 234-244 Stockwell Road, London, SW9 9SP| 020 3794 4798 | 077 1146 9094

CONFIDENTIAL

  1. Your religion or belief (These are based on the Census 2011 categories and are listed alphabetically)

Please return your signed and completed form to Maria Galan| Volunteer Co-Ordinator

Email: |Housing for Women, 6th Floor, Blue Star House 234-244 Stockwell Road, London, SW9 9SP| 020 3794 4798 | 077 1146 9094

CONFIDENTIAL

Buddhist
Christian
Hindu
Jewish
Muslim
No religion
Sikh
Prefer not to say
Other (specify if you wish)

Please return your signed and completed form to Maria Galan| Volunteer Co-Ordinator

Email: |Housing for Women, 6th Floor, Blue Star House 234-244 Stockwell Road, London, SW9 9SP| 020 3794 4798 | 077 1146 9094

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7. What is your legal marital/same-sex civil partnership status?(based on the 2011 census categories)

Please return your signed and completed form to Maria Galan| Volunteer Co-Ordinator

Email: |Housing for Women, 6th Floor, Blue Star House 234-244 Stockwell Road, London, SW9 9SP| 020 3794 4798 | 077 1146 9094

CONFIDENTIAL

Married
Divorced
In a registered same-sex civil partnership
Widowed
Separated
Surviving partner - same-sex civil partnership
Separated but still legally in a same-sex civil partnership
Formally in a same-sex civil partnership which is now legally dissolved
Single
Prefer not to say

Please return your signed and completed form to Maria Galan| Volunteer Co-Ordinator

Email: |Housing for Women, 6th Floor, Blue Star House 234-244 Stockwell Road, London, SW9 9SP| 020 3794 4798 | 077 1146 9094

CONFIDENTIAL

8. Do you perform the role of a carer?

Please return your signed and completed form to Maria Galan| Volunteer Co-Ordinator

Email: |Housing for Women, 6th Floor, Blue Star House 234-244 Stockwell Road, London, SW9 9SP| 020 3794 4798 | 077 1146 9094

CONFIDENTIAL

Yes
No
Prefer not to say

Please return your signed and completed form to Maria Galan| Volunteer Co-Ordinator

Email: |Housing for Women, 6th Floor, Blue Star House 234-244 Stockwell Road, London, SW9 9SP| 020 3794 4798 | 077 1146 9094

CONFIDENTIAL

Please return your signed and completed form to Maria Galan| Volunteer Co-Ordinator

Email: |Housing for Women, 6th Floor, Blue Star House 234-244 Stockwell Road, London, SW9 9SP| 020 3794 4798 | 077 1146 9094