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INA ENGLAND – SPORTS EQUITY MONITORING INA England is committed to supporting diversity. We ask you to respond to this information request positively as it will help us ensure that our policies and practices do not inadvertently discriminate against any person. This form will be detached from your application form and will be kept separately from the information used in the selection process. INA England assures you that any information you provide will only be used to monitor the effectiveness of our policies and we will take steps to ensure this information remains confidential to a limited number of staff in our HR department. In doing so the INA England acknowledges and adopts the following Sport England definition of sports equity: Sports equity is about fairness in sport, equality of access, recognising inequalities and taking steps to address them. It is about changing the culture and structure of sport to ensure it becomes equally accessible to everyone in society. The club respects the rights, dignity and worth of every person and will treat everyone equally within the context of their sport, regardless of age, ability, gender, race, ethnicity, religious belief, sexuality or social/economic status. INA England is committed to everyone having the right to enjoy their sport as a player, coach, match official or spectator in an environment free from threat of intimidation, harassment and abuse. All association have a responsibility to oppose discriminatory behaviour and promote equality of opportunity.

ETHNIC GROUP / ORIGIN What is your ethnic group? Please CIRCLE the most appropriate answer from the section below W W3 D

White

British

W2

D1

White and Black Caribbean

D3

White and Asian

A1

Indian

B1

Caribbean

C1

Chinese

Irish

Any other white background (please specify): Dual

D2

White and Black African

D4

Any other mixed background (please specify):

A

W1

Asian or British Asian

A2

Pakistani

A3

Bangladeshi

A4 Any other Asian background (please specify): B B3 C C2

Black or Black British

B2

African

Any other Black background (please specify): Chinese or other ethnic group Any other (please specify):

DISABILITY The definition of ‘disability’ under the Equality Act 2010 In the Act, a person has a disability if: • They have a physical or mental impairment. • The impairment has a substantial and long-term adverse effect on their ability to perform normal day-to-day activities. Please CIRCLE the most appropriate answer in the sections below. Do you consider yourself to have a disability?

YES

NO

If yes, what is the nature of your disability? Visual Impairment

VI

Hearing Impairment

HI

Physical Disability

PD

Learning Disability

LD

Multiple Disability

MD

Other (please specify)

O

Please give details here of your support needs:

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www.ina-england.co.uk

INA SPORTS EQUITY MONITORING FORM