Equal Opportunities Monitoring Form

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* 1. Which East Durham Creates Project are you involved with/applying for?

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* 2. Where are you based?

County Durham

North East

Wider UK

Outside UK (please specify)

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* 3. What is your postcode?

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* 4. With what gender do you identify?

Female

Male

Non-binary

Prefer not to say

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* 5. Is your gender the same as assigned at birth?

Yes

Prefer not to say

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* 6. What is your sexual orientation?

Bisexual

Gay Man

Gay Woman/Lesbian

Heterosexual/Straight

Prefer not to say

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* 7. What is your age?

Under 16

16-24

25-34

35-44

45-54

55-64

65-74

75+

Prefer not to say

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* 8. How would you describe your ethnic background?

White British

Mixed/Multiple ethnic background

Black/Black British

Asian/Asian British

Prefer not to say

Other (please specify)

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* 9. Do you consider yourself to have a disability?

Yes, I have a disability and/or long term health condition

No, I do not have a disability

Prefer not to say

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* 10. What is your current employment status?

Full-time employment

Part-time employment

Self-employed

Unemployed

Student

Retired

Carer

Prefer not to say