Royal School for the Deaf

Royal School for the Deaf Derby

Confidential Diversity Monitoring Form

Royal School for the Deaf Derby wants to live up to the standards set out in it’s Equality and Diversity policies, procedures and practice and to meet its legal obligations in respect of age, disability, gender, race or ethnic origin, religion or belief and sexual orientation. We need your help and co-operation to do this. By providing this information you are helping us to ensure our policies and practices are non-discriminatory and wherever possible reflect the diverse population of our School and wider communities.

Please email your questionnaire back to Helen Radford at send it marked “Strictly Confidential’ to Helen Radford, Human Resources Manager, Royal School for the Deaf Derby Trust Company, Ashbourne Road, Derby DE22 3BH

Full Name / Role applied for:
1. Please select your age band
16 - 21 / 22 - 30 / 31 - 40 / 41 - 50 / 51 - 59 / 60-65 / Over 65 / Prefer not to say
2. Do you consider yourself to have a disability or health condition?
Yes / No / Prefer not to say
What is the impact of your disability or health condition on your ability to give your best at work?
______
______
3. What is your ethnic group?
A. Asian or Asian British / B. Black or Black British
Bangladeshi / African
Indian / Caribbean
Pakistani / Prefer not to say
Prefer not to say
Any other Asian background, please write in: / Any other Black background, please write in:
______/ ______
C. Chinese / D. Mixed Heritage
Chinese / White and Asian
Prefer not to say / White and Black African
White and Black Caribbean
Prefer not to say
Any other Chinese background, please write in: / Any other Mixed background, please write in:
______/ ______
E. White / 4. What is your religion or belief
British / Buddhist / Muslim
English
Irish / Christian / No religion or belief
Scottish
Welsh / Hindu / Sikh
Prefer not to say
Jewish / Prefer not to say
Any other White background, please write in:
______/ Any other, please write in
F. I do not wish to disclose my ethnic group
4. What is your sexual orientation / 5. Please describe your gender
Bisexual (attracted to people of the same and the opposite sex) / Male / Female
Homosexual (man attracted to other men)
Heterosexual (attracted to people of the opposite sex) / Other / Prefer not to say
Lesbian (woman attracted to other women)
Prefer not to say / Do you identify as transgender (an individual who wants to change their gender to the opposite of that they were assigned at birth)?
Yes / No / Prefer not to say
Other, please write in:
______