Stop It Now! website equality monitoring form
Diversity introduction
Stop It Now! is committed to ensuring that its services, policies and practices are free from discrimination and prejudice and that individuals are treated fairly and according to their needs. Knowing the individual characteristics of our participants can help us to ensure that no one receives less favourable treatment. We would be grateful if you could answer the following survey questions. You are under no obligation to provide the information requested, but it would help us greatly if you did.
The responses to these questions will be held separately from other information that we hold about you and used for statistic and research purposes.
1.
Why did you visit the Stop It Now! website today?
Concerned about your own thoughts and behaviour
Concerned about the behaviour of another adult
Concerned about a child or young person
Professional looking for advice
Adult survivor of abuse
Other (please specify)
2.
How old are you?
Under 18 years
18 – 25 years
26 – 35 years
36 – 45 years
46 – 55 years
56 – 65 years
66 years and over
Prefer not to say
3.
How would you describe your gender identity?
Male
Female
Prefer not to say
I prefer to use my own terms (please tell us more)
4.
Would you consider yourself to have a disability?
Yes
No
Prefer not to say
5.
If you disclosed a disability above, please share with us further information on how this presents itself:
Hearing impairment
Mental health condition
Learning disability/cognitive impairment
Long standing illness or health condition
Neurodiversity such as Autism or ADHD
Visual impairment
Physical impairment
Prefer not to say
Other (please specify)
6.
How would you describe your ethnicity?
White, Caucasian or White British
Black, African, Caribbean or Black British
Asian or Asian British
Middle Eastern or Arab
Mixed or Multiple Ethnic Groups
Gypsy/Traveller
Prefer not to say
Other (please specify)
7.
How would you describe your Sexual Orientation?
Heterosexual/straight
Gay
Lesbian
Bi-sexual
Prefer not to say
Other (please specify)
8.
How would you describe your religious belief?
Christian
Muslim
Sikh
Hindu
Buddhist
Jewish
No religion
Atheist
Prefer not to say
Other (please specify)
9.
How can we improve our services to make them more accessible and useful to you?
Current Progress,
0 of 9 answered
