Equal Opportunities Form

How old are you?

18–24

25–34

35–44

45–54

55–64

Above 65

Prefer not to say

Have you ever identified as trans?

Yes

No

Prefer not to say

Which of the below statements best describes your situation?

I / We feel like we have enough income to support ourselves financially and live a good standard of living.

I / We get by day-to-day but are under pressure. It is difficult to manage unexpected costs and events.

I / We are falling short of a decent standard of living.

I / We can’t afford to eat, keep clean and stay warm and dry.

Prefer not to say.

Which of these categories best represents your experience of mental health problems? (Tick all that apply)

I have personal experience of mental health problems

I use / have used mental health services

I am a family member of somebody who has experienced mental health problems

I am a friend to someone who has experienced mental health problems

I care or look after someone who has mental health problems

None of the above

Prefer not to say

Other

Do you consider yourself to have a long term health condition or learning difference that has a substantial or long term impact on your ability to carry out day to day activities, e.g epilepsy, depression, Autism Spectrum Disorder (ASD), deafness etc.?

Yes

No

Prefer not to say

Equal Opportunities Monitoring Form