Ymca Housing Application Form For Supported Housing Page 7
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8Equal Opportunities Monitoring Form
YMCA Housing operates a philosophy of equal opportunities in all of its work and
responsibilities. The six equality categories we monitor are age, gender, ethnicity,
disability, religion and sexuality. All information will remain confidential.
Please help us to monitor this philosophy, and provide a fair service by
completing this form. Please note that this form is separate from your application,
and will be detached and filed separately from your application
1. I would describe my gender as:
FEMALE
MALE
(please circle one)
2. My age is:
(please circle one)
15
16
17
18
19
20
21
22
23
24
25
3. I consider myself to be:
(please tick one)
Not Disabled
Registered Disabled
Disabled (Not Registered)
4. I would describe my ethnic origin as
:
(please tick one or specify ethnic group)
Asian or Asian British:
Indian
Pakistani
Bangladeshi
Other
Caribbean
African
Other
Black or Black British:
Chinese:
Chinese
White:
British
Irish
Other
Mixed:
White Asian
White and
White and
Other
Black
Black African
Carribean
Other Ethnic Group
(please specify)
5. I would describe my religion as follows:
(please tick one)
Christian e.g. Protestant, Catholic, Methodist, Baptist
Other Religion e.g. Budhist, Hindu, Muslim, Sikh
Atheist (do not believe in God) or Agnostic (believe that the existence of God cannot
be proved or disproved)
Prefer not to answer
6. I would describe my sexuality as
Heterosexual (sexually attracted to the opposite sex only)
Other Sexuality e.g. homosexual (sexually attracted to the same sex) or bisexual
(sexually attracted to both sexes)
Unsure / Undecided
Prefer not to answer
Application/first interview - Application Form V3.1
Updated October 2010
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