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					To:             ALL members of staff

From:           Katie Boyce
                Head of Human Resources


Every year, we send some of the information we hold about you to the Higher Education Statistics
Agency (HESA). We send the information in coded form, and we do not give your name. This
forms your HESA record which contains such details as your ethnic group, nationality, gender,
qualifications and disabilities. HESA will pass your record, or parts of it, to any of the following
organisations that need it to carry out their statutory functions connected with funding higher

         Department for Education and Skills (DfES)
         National Assembly for Wales (NAW)
         Scottish Executive Enterprise, Transport and Lifelong Learning Department (SEETLLD)
         Department for Employment and Learning, Northern Ireland (DEL(NI))
         Higher Education Funding Council for England (HEFCE)
         Higher Education Funding Council for Wales (HEFCW)
         Scottish Higher Education Funding Council (SHEFC)
         Teacher Training Agency (TTA)
         Department of Health (DH)

HESA and the organisations listed above will use the information (which will not include your name)
mainly to produce statistics. This may result in information being published and released to other
approved users including academic researchers and trade unions. Your record will not be used in a
way that could affect you personally.

We will not give your name and contact details to HESA, and HESA and the organisations listed
above take precautions to reduce the risk of you being identified from the information once it is
published and released.

Under the Data Protection Act 1998, you have the right to a copy of the information HESA holds
about you. Because the information HESA holds about you does not include your name and is a
copy of the information we hold, you should contact us if you want to see the information. If you
have any concerns about your information being used for these purposes, please contact HESA.

95 Promenade
GL50 1HZ


Thank you for your assistance and cooperation in this matter.
01 August 2009                                                        Page 1
FOR OFFICE USE ONLY.                                                  HESA QUESTIONNAIRE
(C.H.R.I.S.) Employee Ref: _________________________                  (REF: NJ/EXISTING)
                                                                      (ALL ESTABLISHMENT TYPES)
                                                                        (Academic year 2009/2010)[01AUG09]
Please tick if you are an HPL (hourly paid lecturer)                  

Please tick if you are a Sessional or Fixed Term Sessional Lecturer   

Name: (In capitals please) _____________________________________________________________________

FULL Academic Faculty/Department or Support Department name:
(e.g. FoAHS - Education, FoBCIM - Marketing & Strategy, CSD - User Support, Finance - Payroll)

(In capitals please) ____________________________________________________________________________

Date of Birth: _____________________              Gender (M/F): _______________________

1. Nationality

United Kingdom                         GB        or Other (please specify) ______________________________
(To include England/Scotland/
Wales/Northern Ireland and ‘British’)

2. Ethnicity

Asian or Asian British - Bangladeshi       33    Mixed - White & Black African                42
Asian or Asian British - Indian            31    Mixed - White & Asian                        43
Asian or Asian British - Pakistani         32    Mixed - White & Black Caribbean              41
Other Asian background                     39    Other Mixed background                       49

Black or Black British - African           22    White - British                            11
Black or Black British - Caribbean         21    White - Irish                              12
Other Black background                     29    Other White background                     19
Chinese                                    34
                                                  Other Ethnic background              80
Not Known (e.g. adopted)                 90      (Please Specify)
Information Refused                      98      ___________________________________________________

3. Disability
   Note: If you feel your disability falls within more than one of the criteria listed below, you can mark up to 2
   boxes, based on your own ‘self-assessment’. In this case please indicate these using A and B to indicate
   your main and secondary disability.

   00   No known disability
   51   Specific learning disability (such as dyslexia or dyspraxia)
   52   General learning disability (such as Down's syndrome)
   53   Cognitive impairment (such as autistic spectrum disorder or resulting from head injury)
 54 Longstanding illness or health condition (such as cancer, HIV, diabetes, chronic heart disease, or
 55 Mental health condition (such as depression or schizophrenia)
 56 Physical impairment or mobility issues (such as difficulty using arms or using a wheelchair or
 57 Deaf or serious hearing impairment
 58 Blind or serious visual impairment
 96 Other type of disability
01 August 2009                                                                               Page 2.
FOR OFFICE USE ONLY.                                               HESA QUESTIONNAIRE (cntd)
(C.H.R.I.S.) Employee Ref: _________________________               (REF: NJ/EXISTING)
                                                                   (ALL ESTABLISHMENT TYPES)
                                                                     (Academic year 2009/2010)[01AUG09]

4. Highest Qualification held (Academic or Other) (tick one, the highest, only)

Doctorate                                  01 Other Higher degree  02 PGCE                            03
Other Postgraduate Certificate             09 First degree           11 First degree with QTS         12
Other qualifications at first degree level (inc. professional)        19 Diploma of HE                 21
HND/HNC                                    22 Other undergraduate qualification (inc. professional)    29
‘A’ level, Scottish Higher or equiv. (NVG/SVQ Level 3)       31        Other qualification             97
‘O’ level/GCSE or equiv. (NVQ/SVQ level 2                    32        No formal HE qualification      98

5. Discipline/Subject of Highest Qualification (Academic or Other)
   (as noted in 4 above) for Qualifications up to CODE 29 ONLY

Please specify _________________________________________________________________________________

6. Main Employment prior to joining London South Bank University on your current contract.
   (If you were employed by London South Bank University prior to this but had a break of service
   between contracts and have not been employed elsewhere during this break then please use the
   option “Not in regular employment  21” from the list below)

Current Institution                                   00    Other employment in an overseas country      10
Another HEI in UK.                                    01    Other public sector in UK                    11
HEI in an overseas country                            02    Private industry/commerce in UK              12
Other education institution in UK                     03    Self-employed in UK                          13
Other education institution in an overseas country    04    Other employment in UK                       14
Research institution in the UK                        05    Other employment in an overseas country      15
Research institution overseas                         06    Not in regular employment                    21
Student in UK                                         07
Student in an overseas country                        08
NHS/General medical or general dental practice        09
   in UK.

7. Name of Previous Higher Education Institution if the option “Another HEI in UK  01” is ticked in
   question 6. above. e.g. University of Greenwich, University of Derby.

Name: (In capitals please) _____________________________________________________________________