Volunteer monitoring data form

1. Volunteer monitoring data Form

To help us build a picture of the Healthwatch Northumberland volunteer team and monitor equality of opportunity, we would be grateful if you could complete this form.

If there are any questions you would prefer not to answer, please leave them blank or select 'Prefer not to say'. This form is entirely optional and the information collected will be used anonymously for monitoring purposes only.

Thank you!
 
 

1. What is the first part of your post code? (eg NE46)

 

2. What is your age range? 

 

3. How would you describe your ethnicity? 

 

4. Do you have a religious belief? 

 

5. Do you consider yourself to have a disability? 

 

6. Do you have a long-term physical or mental health condition?     

 

7. Do you consider yourself to be a carer?

 

8. What is your marital status?

 

9. Are you currently pregnant, on maternity leave or breastfeeding?

 

10. What is your sex? ( A question about gender follows)

 

11. Is the gender you identify with the same as your sex registered at birth?

 

12. Sexual orientation: Which of the following options best describes how you think of yourself?