Equality, Diversity & Inclusion Monitoring Form Equality, Diversity & Inclusion Monitoring Form All information submitted in this section will be anonymous and will not be published anywhere. Are you based in the Wakefield district?(Required) Yes No If yes:(Required) 1. Ackworth, North Elmsall and Upton 2. Airedale and Ferry Fryston 3. Altofts and Whitwood 4. Castleford Central and Glasshoughton 5. Crofton, Ryhill and Walton 6. Featherstone 7. Hemsworth 8. Horbury and South Ossett 9. Knottingley 10. Normanton 11. Ossett 12. Pontefract North 13. Pontefract South 14. South Elmsall and South Kirkby 15. Stanley and Outwood East 16. Wakefield East 17. Wakefield North 18. Wakefield Rural 19. Wakefield South 20. Wakefield West 21. Wrenthorpe and Outwood West If no:(Required) No, but I am originally from or have close connections to the Wakefield District No, I am based elsewhere in Yorkshire No, I am based outside Yorkshire Age:(Required) 18 - 24 25 - 34 35 - 44 45 - 54 55 - 64 65 - 74 75 - 84 85+ I do not wish to disclose this information Long term health and disability* Does your health or disability prevent you from doing things you want to, need to, or have to?(Required) Yes, limited a lot Yes, limited a little No I do not wish to disclose this information *Disability or health issues are those which have lasted, or are expected to last, at least 12 months, and include problems relating to old age.Gender Identity:(Required) Male Female Non-Binary Prefer not to say Other Race, Ethnic or Cultural Origin:(Required) White English/Welsh/Scottish/Northern Irish/British White Irish White Gypsy or Irish Traveller Other white background White and Black Caribbean White and Black African White and Asian Any other mixed/multiple ethnic background Asian/Asian British Indian Asian/Asian British Pakistani Asian/Asian British Bangladeshi Asian/Asian British Chinese Any other Asian/ Asian British background Black African Black Caribbean Any other Black/African/Caribbean background Any other ethnic group and/or background I do not wish to disclose this information Sexual Orientation:(Required) Bi-sexual Gay Man Gay Woman or Lesbian Heterosexual or Straight I do not wish to disclose this information Other Please indicate the highest level of education that you hold:(Required) No formal education Secondary school / high school Foundation Year or Diploma University degree (first degree held) Postgraduate degree Another type of degree/course I do not wish to disclose this information
