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Strategic Housing Investment Plan 2010 - Falkirk Council

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<strong>Strategic</strong> <strong>Housing</strong> <strong>Investment</strong> <strong>Plan</strong> 2011 - 2016 Appendix 3b<br />

Equalities Information<br />

DIVERSITY MONITORING FORM 2009<br />

1. Name _______________________________<br />

2. Gender<br />

(a) Are you: Female Male<br />

3. Age<br />

I am ____ years old and my date of birth is: __/___/____<br />

4. Relationship Status<br />

What is your relationship status?<br />

1 Never married and never registered a same sex civil partnership<br />

2 Married 7 In a registered same-sex civil partnership<br />

3 Separated, but still 8 Separated, but still legally in a same-sex<br />

legally married civil partnership<br />

4 Divorced 9 Formerly in a same-sex civil partnership<br />

which is now legally dissolved<br />

5 Widowed 10 Surviving partner from a same-sex civil<br />

partnership<br />

6 Living with Partner 11 Prefer not to say<br />

5. Religion<br />

What religion, religious denomination or body do you belong to?<br />

1 None 7 Church of Scotland<br />

2 Roman Catholic 8 Other Christian<br />

3 Muslim 9 Buddhist<br />

4 Sikh 10 Jewish<br />

5 Hindu 11 Pagan<br />

6 Another religion, please write in _________________________<br />

12 Prefer not to say<br />

6. National Identity<br />

How would you describe your national identity?<br />

* Tick all that apply<br />

1 Scottish 5 English<br />

2 British 6 Polish<br />

3 Indian 7 Other, please write in ________________<br />

4 Prefer not to say<br />

7. Ethnic Group<br />

What is your ethnic group? *<br />

* Choose ONE section from A to E, then tick ONE box which best describes<br />

your ethnic group or background.<br />

A White<br />

1 Scottish 6 English

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