Volunteer Demographics and Monitoring Form

Date form completed

Date form completed: Date

Thank your for taking the time to complete this form.

Your Data
Manchester Mind complies with the General Data Protection Regulation (GDPR). We are registered with the Information Commissioner’s Office (ICO) and comply with their requirements and procedures.

Some of your data is collected for reporting and monitoring, where this happens we will describe in more detail how and why we are asking for these details

We do not, and never will, sell your data for marketing purposes.

Your data will be stored in a password protected database that only current Manchester Mind staff can access.

To find out more about how and why we store and process your data, and how you can check the data we hold on you is valid, and ask for changes, please see our full Privacy Notice.

Your Details

First Name

Last Name

Phone Number

Postal Code

Equal Opportunities Monitoring

The questions we ask about about Equal Opportunities and Your Physical and Mental Health will help us to:

1) Demonstrate that we comply with equality legislation aimed at preventing discrimination in the delivery of our services.

2) Make our services accessible to everyone, including people who struggle to get what they need from other services.

We will also share this data in anonymised form with some of our funders to help demonstrate the impact of their support for us. (Equal opportunities and demographic data will be shared without any information identifying you as an individual). Funders we share this information with are, Mind (our National Partners).

These questions ask for information that is classed as sensitive personal data under the GDPR. (Questions about your ethnicity, sexuality and health). The information gathered will be used for monitoring and statistical purposes as described above.

If you do not want to share this information about yourself with us, you are free to leave any question unanswered.

Date of Birth

How do you describe your gender?

Female

Male

Non-binary

Another/ prefer to self-describe

Prefer not to say

Other gender

Have you ever identified as trans?

Yes

Prefer not to say

What is your sexual orientation?

Other sexuality

How do you describe your ethnic background?

Other Ethnic background

What is your current working situation?

Other work situation

Which of the following best describes your current living arrangement?

Other Living Arrangements

Anyone in your household receive benefits

Yes

Don't know

Prefer not to say

Thinking about your financial situation, which of the below statements best describes your situation?

Your Physical and Mental Health

At Manchester Mind we understand that there are many different ways of talking about and understanding mental health problems.

We are here to help you if you are feeling overwhelmed, if you have a long-term condition, if you are struggling at the moment or if you’re not sure how you want to talk about your mental health yet.

We ask the following questions as they help us to understand how we can best support you.

Which of these categories best represents your experience of mental health problems? (Please tick all that apply)

I have personal experience of mental health problems

I use / have used mental health services

I care or look after someone who has mental health problems

Any other (please specify if you wish)

None of the above

Prefer not to say

Other experience of Mental Health?

If you have personal experience of mental health problems, how would you best describe the symptoms you have experienced? (Please tick all that apply)

Anger

Anxiety

Bi-polar disorder

Compulsions

Depression

Difficulty Sleeping

Eating problems

Hallucinations (auditory or visual)

Irrational thoughts

Low mood

Mood swings

Obsessions

Panic

Paranoia

Phobia

Post traumatic disorder

Psychosis

Schizophrenia

Self harm

Stress

Suicidal Thoughts

Other

Prefer not to say