Private & Confidential
SVHA
EQUAL OPPORTUNITIES MONITORING INFORMATION
     (HOUSING)

Scottish Veterans Housing Association Limited aims to be an equal opportunities provider. Our aim is to ensure that
everyone who applies for housing with the Association whatever their marital status, age, race, colour, ethnic origin,
disability or sexual orientation will receive equal treatment. To ensure our selection process is free of bias the information
given on this form will be separated from the main application form before selection is made.

For this purpose the definition of disability is "A physical or mental impairment, which has substantial and long term
adverse effects on their ability to carry out normal day to day activities".

To ensure our policy is working, we would be grateful if you would complete this questionnaire for each
member of your family (if applicable)

Please note: This questionnaire will be used to produce depersonalised statistical reports for analysis
only and will not be used as part of the selection process.

Thank you for your co-operation.

Sex:   Male   Female              
Marital Status: Married   Single        
    Separated/Divorced                
Please state nature of any considered            
disability:            
                       
  Ethnic Origin: White     Indian    
  Black Carribean     Pakistani    
  Black African     Bangladeshi    
  Black (Other)     Chinese    
Date of Birth:         Other          
Age: Please enter in years       (Please Specify)          
Surname:           Forenames:    
                       
Signed:           Date: