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Equalities Monitoring Form

Please help us by completing this Equalities Monitoring Form. At Allsorts we want to ensure everyone is treated equally and fairly and it will help to inform us whether our services are reaching a wide cross section of the community.

Filling in this form is voluntary and please be reassured that all information collected will be securely stored in line with data protection laws.

Please complete this form for everyone included in your membership. If you are joining as a family, please include all members of the family.

Name of the main contact for the membership

First name Surname

Email address of the main contact for the membership

Please answer our questions below

For each answer please tell us how many of your family members this applies to.

How do you/your family members describe your gender?

A woman

Please write down the number of family members

A man

Please write down the number of family members

Non-binary

Please write down the number of family members

In another way (please describe)

Please write down the number of family members (and describe)

Prefer not to say

Please write down the number of family members

Do you identify as transgender?

Yes

Please write down the number of family members

No

Please write down the number of family members

In some ways (please describe)

Please write down the number of family members (and describe)

Prefer not to say

Please write down the number of family members

How do you/your family members describe your sexual orientation?

Bisexual

Please write down the number of family members

Gay

Please write down the number of family members

Lesbian

Please write down the number of family members

Heterosexual

Please write down the number of family members

In another way (please describe)

Please write down the number of family members (and describe)

Prefer not to say

Please write down the number of family members

How do you/your family members describe your religion or belief?

No religion or belief

Please write down the number of family members

Buddhist

Please write down the number of family members

Christian

Please write down the number of family members

Hindu

Please write down the number of family members

Jewish

Please write down the number of family members

Muslim

Please write down the number of family members

Sikh

Please write down the number of family members

Prefer not to say

Please write down the number of family members

Other religion or belief

Please write down the number of family members

How do you/your family members describe your race?

Mixed/ Multiple Ethnic Group

Please write down the number of family members

Asian/ Asian British

Please write down the number of family members

Black/ African/ Caribbean/ Black British

Please write down the number of family members

Other Ethnic Group

Please write down the number of family members

English/ Welsh/ Scottish/ Northern Irish/ British

Please write down the number of family members

Irish

Please write down the number of family members

Gypsy or Irish Traveller

Please write down the number of family members

Other White

Please write down the number of family members