Diversity data questionnaire

Please answer each question in turn by choosing one option only, unless otherwise indicated. If you do not wish to answer the question please choose the option “Prefer not to say” rather than leaving the question blank.

Age*

From the list of age bands below, please indicate the category that includes your current age in years:

Gender*

What is your gender?

Male
Female
Prefer not to say

The Equality Act 2010 generally defines a disabled person as someone who has a mental or physical impairment that has a substantial and long-term adverse effect on a person’s ability to carry out normal day-to-activities.

(a) Do you consider yourself to have a disability according to the definition in the Equality Act?*

Yes, limited a lot
Yes, limited a little
No
Prefer not to say

(b) Are your day-to-day activities limited because of a health problem or disability that has lasted, or is expected to last, at least 12 months?

Yes, limited a lot
Yes, limited a little
No
Prefer not to say

How would you decribe your ethnic group?*

Asian/Asian British
Black/African/Caribbean/Black British
White
Other ethnic group

Asian/Asian British: are you...

Black/African/Caribbean/Black British

African
Caribbean

White

British/English/Welsh/Northern Irish/Scottish
Irish
Gypsy or Irish Traveller

Other ethnic group

Arab
Prefer not to say

Religion or belief

What is your religion or belief?

Sexual orientation

What is your sexual orientation?

Socio-economic background

(a) If you went to University (to study a BA, BSc course or higher) were you part of the first generation of your family to do so?

Yes
No
Did not attend University
Prefer not to say

(b) Did you mainly attend a state or fee paying school between the ages 11 – 18?

UK State School
UK Independent/Fee-Paying School
Attended school outside the UK
Prefer not to say

Child-Care responsibilities

Are you a primary carer for a child or children under 18?

Yes
No
Prefer not to say

Thank you for completing this questionnaire.

Diversity data questionnaire

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