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Equality & Diversity Form – Mercury Playwrights
What is your gender?
*
Woman
Man
Non-binary
Prefer not to say
Prefer to self-describe (let us know below)
What is your gender?
Is your gender different from the sex you were assigned at birth?
Yes
No
Prefer not to say
Please indicate your age range
*
16-19
20-34
35-49
50-64
65-74
75+
Prefer not to say
What is your ethnic background?
*
Asian Ethnicity – Asian British
Asian Ethnicity – Bangladeshi
Asian Ethnicity – Chinese
Asian Ethnicity – Indian
Asian Ethnicity – Another Asian Background
Black Ethnicity – African
Black Ethnicity – Black British
Black Ethnicity – Caribbean
Black Ethnicity – Another Black Background
Mixed Ethnicity – Black and Asian
Mixed Ethnicity – White and Asian
Mixed Ethnicity – White and Black African
Mixed Ethnicity – White and Black Caribbean
Mixed Ethnicity – Another Mixed Background
White Ethnicity – British
White Ethnicity – Irish
White Ethnicity – Gypsy or Irish Traveller
White Ethnicity – European
White Ethnicity – Another White Background
Another Ethnicity – Latin American
Another Ethnicity – Middle Eastern – Arab
Another Ethnicity – Middle Eastern – North African
Another Ethnicity – Middle Eastern – Another Region
Another Ethnicity – Another Ethnic Group
Another Ethnicity – Prefer not to say
Prefer to self-describe (please let us know below)
What is your ethnic background?
Equality Act 2010
A person is covered under the Equality Act 2010 if they have a physical or mental impairment, which has a substantial and long term (over 12 months) adverse effect on their ability to carry out normal day to day activities. People who have had such a disability in the past are also covered.
Do you consider yourself to be covered by this act?
*
Yes
No
Prefer not to say
Unknown
If yes, please indicate what type of disability/impairment:
Hearing impairment/Deaf
Mental health condition
Neurodiversity
Other long term/chronic conditions
Physical disabilities
Visual impairment
Prefer not to say
What is your sexual orientation?
*
Bisexual
Gay Man
Gay Woman/Lesbian
Heterosexual/Straight
Queer (none of the above)
Prefer not to say
Prefer to self-describe (please let us know below)
What is your sexual orientation?
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