Join Bristol Community Transport

Equalities Monitoring Form

• Disabled people
  For Bristol Community Transport purposes, a disabled person is someone who has great difficulty, or cannot access conventional public transport.
• Do you consider yourself a disabled person?
  Yes
  No
  Prefer not to say
  
• Ethnic origin
  Please select English Welsh Scottish Northern Irish Irish British Gypsy (including English Scottish and Roma Gypsy) Irish Traveller Eastern European White and Black Caribbean White and Black Asian White and Black African (non Somali) Any other mixed/multiple ethnic background Caribbean African (non Somali) Somali Any other black/African/Caribbean Indian Pakistani Bangladeshi Chinese Any other Asian background Arab Iranian Iraqi Kurdish Turkish Other Prefer not to say
• Gender
  Please select Male Female Transgender Prefer not to say
• Sexual orientation
  Please select Heterosexual Lesbian Gay Bisexual Prefer not to say
• Age group
  Please select 15 years or under 16-24 years 25-49 years 50-64 years 65-74 years 75 years and over Prefer not to say
• religion
  Please select Christian Buddhist Hindu Jewish Muslim Sikh Other No religion Prefer not to say
• It helps us to know whether we are reaching all disabled people. Please can you tick the relevant impairment (disability) group below and you are welcome to tick more than one box if appropriate.
  Physical Impairment
  Visual Impairment
  Hearing Impairment
  Deaf BSL User
  Learning Difficulties
  Specific Learning Difficulties e.g. dyslexia
  A Health Condition e.g. multiple sclerosis, cancer
  Mental and Emotional Distress
  Prefer not to say
  
• Use of Data
  Information provided will be treated confidentially and in accordance with GDPR regulations and only used to ensure that everyone is treated fairly.

• Robot checking, you must tick the 'I am not a robot' box before submitting or saving your information.