2010 src elections equality monitoring form for candidates

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  1. Monitoring of Students’ Union Council Candidates<br />Queen’s University Students’ Union is committed to ensuring that all of its members are treated equally and that they get involved in the decision making processes of the Union. You are asked to complete this form so that the combined information from all candidates can be used to bring to light those groups in the student community where more work needs to be done in order to encourage them to run for positions such as those on the Students’ Union Council.<br />This form is entirely anonymous and the information provided will have no impact on the outcome of the electoral process. The information you provide will be used to develop a strategy that will make candidates in future elections more representative of the overall student community.<br />Please tick the relevant box<br />Gender<br />Please indicate your gender:Male<br />Female<br />Community Background<br />Please select which best describes your background, even if you not a practising Roman Catholic or Protestant:<br />Protestant background<br />Roman Catholic background<br />Neither<br />Nationality<br />What is your place of birth?Northern Ireland<br />Republic of Ireland<br />England/Scotland/Wales<br />Other (please specify) ____________________ <br />Race/ethnic origin<br />Please select which ethnic group nest describes you:<br />White BritishWhite Irish<br />White OtherAsianMixed ethnic groupBlack<br />Other ethnic group (please specify) ____________________<br />Dependants<br />Do you have any dependents?Yes<br />No<br />If yes, are those dependents:Children<br />Person(s) with a disability<br />Elderly person(s)<br />Sexual Orientation<br />My sexual orientation is towards someone:A different sex<br />Of the same sex<br />Both sexes<br />Disability<br />Do you have a disability?Yes<br />No<br />If yes, please indicate the nature of your disability:<br />Physical Impairment (such as difficulty using your arms or mobility issues which means using a wheelchair or crutches)<br />Sensory Impairment (such as being blind/having a serious visual impairment or being deaf/having a serious hearing impairment)<br />Learning Disability/Difficulty (such as Down’s syndrome or dyslexia or cognitive impairment, such as autistic spectrum disorder)<br />Long-Standing Illness or Health Condition (such as cancer, HIV, diabetes, chronic heart disease or epilepsy)<br />Mental Health Condition (such as depression or schizophrenia)<br />Other (please specify)<br /> ________________________________________<br />Thank you for taking the time to complete this form.<br />Please return it with your nomination form.<br />