Equality Monitoring Form (EMF001)

Please complete this Equality Monitoring Form.

We need this information to ensure that our policies, practices and procedures promote equality of opportunity. It is also a requirement of our funding grants and the Legal Aid Agency.

All information provided will be kept confidentially in accordance with the General Data Protection Regulation (GDPR). We hold your information on our Case Management System. For Legal Aid matters, we are required to share your personal equality data. For funding grants, this data is anonymised for reporting purposes.

Please choose your local authority

Other local authority: *

Sex *

Is your current gender presentation the same as the one observed at birth? *

How would you describe your sexuality? *

Personal status *

What age group do you belong to? *

Do you consider yourself to have a disability? *Under the Equality Act 2010 a disability is defined as a ‘physical or mental impairment which has, or had a substantial and long term adverse effect on a person’s ability to carry out normal day to day activities’.

Please indicate which ethnic group you belong to *

Country of Birth *

Please indicate which religion you consider yourself to belong to *

Other religion: *

Are you? *

What is your average monthly income (£) *

Salary Calculation (Average Monthly Income x12)

Are you in receipt of any benefits? *

Please write which benefit(s) you receive: *

Data Protection Statement

The information in this Equality Monitoring Form is important to us because it allows us to monitor our compliance with the law and to ensure that our services are reaching a diverse group of service users. We are also asked, from time to time, to report it, in a anonymised form, to our funders. Any information you provide will be treated with confidence and kept confidential. Because of the nature of this information, we need your consent before we can collect and use it.

You have the right to be told what data we hold about you (though you are likely to have provided us with that data) and to have it corrected if it is wrong. You may have other rights under the data protection legislation and you can out more about these rights from the Information Commissioner’s Office at www.ico.org.uk. For details of our full Privacy Notice, please visit https://suffolklawcentre.org.uk/about-us/privacy-notice/

I consent to you using this information for the purpose of equality and diversity monitoring. I understand that I can withdraw my consent at any time.

Yes, I agree.

Please enter your full name in place of a signature. *