Youth Platform Equality Monitoring Form 2020

To be completed by young person

It is essential for Peckham Platform to know who is using our services so we can give feedback to our funders.

Question Title

* 1. Ethnicity

White - British

White - Irish

White - Traveller

White - Other (please specify)

Mixed - White and Black Caribbean

Mixed - White and Black African

Mixed - White and Asian

Mixed - Other (please specify)

Black - Caribbean

Black - African

Black - Other (please specify)

Asian - Indian

Asian - Pakistani

Asian - Chinese

Asian - Other (please specify)

Prefer not to say

Other (please specify)

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* 2. Age

Question Title

* 3. Gender Identity

Male

Female

Non-Binary

Agender

2Spirit

Prefer not to say

Other (please specify)

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* 4. Sexual orientation

Heterosexual

Gay

Lesbian

Bisexual

Pansexual

Asexual

Prefer not to say

Other (please specify)

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* 5. Religion/Faith

Christian

Muslim

Buddhist

Hindu

Atheist

Prefer not to say

Other (please specify)

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* 6. Do you consider yourself disabled?

Yes

Prefer not to say

Youth Platform Equality Monitoring Form 2020

To be completed by young person

Question Title

* 1. Ethnicity

Question Title

* 2. Age

Question Title

* 3. Gender Identity

Question Title

* 4. Sexual orientation

Question Title

* 5. Religion/Faith

Question Title

* 6. Do you consider yourself disabled?

Question Title

* 7. Date completed