One World Media CAN Mezzanine

32-36 Loman StreetLondon SE1 0EH

+44 (0) 20 7922 7941

www.oneworldmedia.org.uk

Equal Opportunities Monitoring Form

Gender Identity: Female Male Non-binary Prefer not to say

Sexual Orientation:Bisexual Gay Man Gay Woman/Lesbian Heterosexual/Straight Prefer not to say

I would describe my ethnic origin as: A: White

British Irish Gypsy or Traveller Any other White Background

B: Mixed White and Black Caribbean White and Black African White and Asian Any other Mixed/Multiple Ethnic

C: Asian or Asian British

Indian Pakistani Bangladeshi Chinese

D: Black or Black British African Caribbean Any other Black/African/Caribbean

E: Other Arab Any other ethnic Group Prefer not to say

Page 1 of 2

One World Media CAN Mezzanine

32-36 Loman StreetLondon SE1 0EH

+44 (0) 20 7922 7941

www.oneworldmedia.org.uk

Do you identify as disabled? Yes No Prefer Not to Say

If you identify as disabled, how would you describe your disability? Visual Impairment Hearing Impairment/Deaf Physical Disabilities Physical Disabilities Cognitive or learning Disabilities Mental Health condition Other Long term/Chronic Conditions

Page 2 of 2