New Residents' Panel 2010

Thank you for volunteering to become a member of Community Matters, the residents' panel for Thanet District Council.

To help us understand who is a member of the panel we would appreciate you completing the following questionnaire.  All of the information you give us is confidential and we will never use your name in any of our findings, or pass your name and details to other organisations.  Your data will be held securely in accordance with the Data Protection Act 1998.  It will only be used for the purposes specified and will not be published on an individual basis.

Unfortunately if you or another member of your household is a Councillor then you will not be able to join the Community Matters Residents' Panel.

1.	Are you, or any other member of your household, a councillor?
	Yes (Please go to end of survey)
	No (Please go to next question)

2.	What is your name?
	Title
	First name
	Surname

3.	What is your address?
	House number or name
	Road/street name
	Town
	Postcode

4.	What is your home and/or mobile telephone number?
	Home phone number
	Mobile phone number

5.	What is your gender?
	Male
	Female

6.	What is your age?
	18-24
	25-34
	35-44
	45-54
	55-64
	65-74
	75+

7.	To which of these groups do you consider you belong to?
	White: British
	White: Irish
	White: Other
	Black or Black British: Caribbean
	Black or Black British: African
	Black or Black British: Other
	Mixed: White & Black Caribbean
	Mixed: White & Black African
	Mixed: White & Asian
	Mixed: Other
	Asian or Asian British: Indian
	Asian or Asian British: Pakistani
	Asian or Asian British: Bangladeshi
	Asian or Asian British: Other
	Chinese
	Other ethnic group

	Other (please specify)

8.	Do you have any long term illness, health problem or disability?
	Yes
	No

9.	If yes, which of the following does your disability affect?
	Your vision
	Your hearing
	Your mobility
	Your speech
	Your mental health
	Your learning ability
	Epilepsy
	Asthma
	Diabetes

	Other (please specify)

10.	How long have you been living in the area?
	Under 1 year
	1-2 years
	3-5 years
	6-10 years
	11-20 years
	21+ years
	Don't know/can't remember

11.	Which of these best describes the ownership of your home?
	Owned outright (including leasehold)
	Buying on mortgage
	Rented from local authority
	Rented from housing association
	Rented from private landlord

	Other (please specify)

12.	Do you have dependent children living at home?
	Yes, aged under 12
	Yes, aged between 12 and 21
	No

13.	Which of these activities best describes what you are doing at present?
	Employee in full-time job (30 hours plus per week)
	Employee in part-time job (under 30 hours per week)
	Unemployed and available for work
	Permanently sick/disabled
	Self employed full or part-time
	Wholly retired from work
	On a government supported training programme (e.g. Modern Apprenticeship/Training for Work)
	Looking after the home
	Full-time education at school, college or university

	Other please state

Please think about any group(s) to which you belong, which makes decisions that affect your local area. Please exclude anything that was a requirement of your job.

14.	In the past 12 months have you...
		Yes		No
	Been a local councillor (for the local authority, town or parish)
	Been a member of a group making decisions on local health or education services.
	Been a member of a decision-making group set up to regenerate the area
	Been a member of a decision-making group set up to tackle local crime problems
	Been a member of a tenants group decision making committee
	Been a member of a group making decisions on local services for young people
	Been a member of another group making decisions on services in the local community

	If you have been a member of any other community or residents' group please state:

15.	To ensure that we consult and involve you in the things that matter, please tell us which of the following council services you would like to know more about, and which you would like to get involved in?
		Would like to know more about		Would like to get involved in
	Arts
	Asset management
	Benefits
	Communicating, informing and involving residents
	Community Safety
	Council Tax
	Customer services
	Environmental Health
	Housing and homelessness
	Leisure and park facilities
	Planning and Conservation
	Regeneration
	Sports
	Thanet's Gateway Plus
	The council's budget
	Tourism and events
	Waste, recycling and street cleansing

	Other please state

16.	How would you like to receive information about residents' panel events and surveys?
	Letter by post
	E-mail
	Telephone call
	Text message
	Council website

	Other please state

17.	Finally, how strongly do you agree or disagree that you can influence decisions affecting your local area?
	Definitely agree
	Tend to agree
	Tend to disagree
	Definitely disagree
	Don't know

	Any other comments

Thank you for completing this survey