Gloucestershire FA compiles anonymous information on those individuals accessing its services and activities.

The equality and diversity monitoring form gathers data on a person’s characteristics. These characteristics are sometimes referred to as race, gender, transgender, disability, religion and belief, sexual orientation, age and disability. Monitoring allows us to understand the makeup of those accessing our activities and programmes and analysis enables us to adapt and meet the needs of individuals if required. The information we receive is used solely for monitoring and statistical purposes.

Everyone is encouraged to complete this survey, but if you prefer not to disclose some personal information, each question has a ‘prefer not to say’ option that you can select.

Indicate in the appropriate box your ethnic background. Ethnic categories are not about nationality, place of birth or citizenship. They are about the group to which you feel you belong to. The descriptions below are taken from the 2011 census.

Under the Equality Act 2010, disability is defined as a physical or mental impairment that has a substantial and long-term adverse effect on the ability to carry out normal day to day activities. Substantial means more than minor or trivial. Impairment covers, for example, long term medical conditions such as asthma and diabetes, and fluctuating or progressive conditions such as rheumatoid arthritis or motor neurone diseases. A mental impairment includes mental health conditions (such as bipolar disorder or depression), learning difficulties (such as dyslexia) and learning disabilities (such as autism and Down’s syndrome). Some people including those with cancer, multiple sclerosis and HIV/AIDS are automatically protected as disabled people by the Act.

If you have indicated yes to having a disability, please indicate the impairment(s) you feel apply to you:

How would you describe the religion to which you feel you belong?

Which of the following options best describe how you think of yourself?

Is there anything we can do or put in place which would make it easier for us to offer you an equal service? (For example, documents in large print, hearing loop etc.)

It would be helpful for Gloucestershire FA to know of any barriers you have faced when dealing with us.