Staffordshire County Council

Application to join the Staffordshire People's Panel

 

Thank you for showing an interest in becoming a member of the Staffordshire People's Panel.  To become a member of the Panel we first need to find out some information about you. These questions help us to ensure that we get the views and opinions of a wide cross-section of people. All responses will be treated in the strictest confidence. Please note: a) Staffordshire County Council employees or people living with employees cannot join the panel. b) Members of other residents panels such as the Staffordshire police panel or district council panels cannot join the panel.  This is to ensure impartiality.

 

If you would like to be a member of the Staffordshire People's Panel, please answer the following questions and click submit at the end of the page.

If you have any questions please contact Wendy Bailey on 01785 854267

Q1
  Please cross this box to confirm you are not an employee or living with an employee of Staffordshire County Council
 
   
Q2
  Please cross this box to confirm you do not belong to any other residents panel, such as the Staffordshire police panel or your district council panel
 
   
Q3
 
 
Q4
 
 
Q5
 
 
Q6
  If you are happy for the Panel to contact you via telephone, please enter your home and mobile telephone numbers in the boxes below
 
 
Q7
  Are you...? (please select one only)
 
 
 
Q8
   
Q9
  Do you have any long standing illness, disability or infirmity? (please select one only)
 
 
 
Q10
  Does this limit your activities in any way? (please select one only)
 
 
 
Q11
  To which of the following groups do you consider you belong? (please select one only)
 
 
 
 
 
 
 
 
 
 
Q12
  In which of these ways does your household occupy your current accommodation? (please select one only)
 
 
 
 
 
Q13
  How long have you lived in Staffordshire? (please select one only only)
 
 
 
 
 
 
   
Q14
  Are you...? (please select one only)
 
 
 
 
 
 
   
Q15
  How many children aged 17 and under are living in your household? (please select one only)
 
 
 
 
 
Q16
  How many adults aged 18 or over, including yourself, are living in your household? (please select one only)
 
 
 
 
 
 
   
Q17
  Which of these activities best describes what you are doing at present? (please select one only)
 
 
 
 
 
 
 
Q18
  If you are currently employed, do you work in Staffordshire? (please select one only)
 
 
 
Q19
  If you are currently employed, how do you normally get to work? (please select one only)
 
 
 
 
 
 
 
 
Q20
  Do you care for, or help to care for, a relative or friend with a long-term limiting illness or disability, including problems linked with old age? (please select one only)
 
 
 
Q21
  Do you personally use the internet at home? (please select one only)
 
 
 
Q22
  Which of the following Staffordshire People's Panel consultation activities would you like to have the opportunity to get involved with? (please select all that apply)
 
 

THANK YOU FOR COMPLETING THESE QUESTIONS - ALL RESPONSES ARE TREATED IN CONFIDENCE.