Innovation Grant Application Form

IPEM is committed to ensuring its appointments are accessible to everyone regardless of gender, ethnic origin, disability, religion, sexual orientation, gender reassignment, socio-economic background, caring responsibilities or age. We routinely gather and analyse diversity data to assist with assessing the extent to which we are achieving this aim. Any information you give will help us improve our activities and processes. This form will be detached from the main application and will be treated as strictly confidential in accordance with the Data Protection Act and our privacy policy. We have based the questions and answer options on the 2021 census and Wellcome Trust guidance.

What is your sex (Use the sex on your birth certificate or Gender Recognition Certificate) *

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

Please self describe your gender identity

Which of the following best describes your sexual orientation? *

Please self describe your sexual orientation

Do you have any physical or mental health conditions, disabilities or illnesses lasting or expected to last longer than 12 months? *

Do you have any caring responsibilities (including children, persons with a disability or older adults) *

When you were 18, had any of your parents or guardians completed a university degree course or equivalent (e.g. BA, BSc or higher)? *

What is your ethnic group (you can tick more than one) ASIAN BRITISH

Bangladeshi

British

Chinese

Indian

Pakistani

Other Asian Background

Other Asian background (please specify)

BLACK/AFRICAN/CARIBBEAN/BLACK BRITISH

African

British

Caribbean

Other Black background

If other, please specify

MIXED/MULTIPLE ETHNIC GROUPS

White and Black African

White and Black British

White and Black Caribbean

White Asian

Other mixed background

Other Mixed background (please specify)

OTHER

Arab

Prefer not to say

Other, please state

WHITE

British

English

Gypsy/Irish Traveller

Irish

Scottish

Welsh

Other white background

Other White Background

What is your Religion/belief?

Please self describe your religion

For the purposes of compliance with the Data Protection Act 1998, I hereby confirm that by completing this Equality and Diversity Monitoring Form I give my consent to the organisation processing the data supplied for the purpose of equal opportunities monitoring as per our privacy policy. *