You are invited to join Community Voice - Cumbria's Citizens Panel Have you ever wondered how decisions are made about services in your local area?  Community Voice is the Citizens’ Panel for Cumbria and is a way for local residents to influence local decision making.  Members receive four survey forms each year on a range of topic - recent surveys have covered roads and transport, housing, recycling, internet use and criminal justice.  You can also choose to receive an additional four survey forms each year specifically on Police-related issues.  Your membership can last up to three years but you may opt out at any time if you wish to. To join Community Voice please complete this online form.  The form is quick and easy to complete -- for most questions you can simply tick the relevant box(es).  You will be taken through the form a section at a time, and can go back and change your answers if you wish to.  Your details will be securely sent to Craigforth when you click 'submit'. If you have any questions about completing the form, or about the Panel more generally you can call Craigforth on freephone 0800 027 2245.   To start please enter the reference number from your invitation letter in the box.

Your Contact Details Please be assured that we will only use your contact details to run consultation exercises through Community Voice. Q1 Your Name:     Your address, including postcode:     Your email address (optional):

About you We need to collect the following information to confirm your Citizens’ Panel membership.  Please be assured your details are completely confidential and will only be used for analysis of survey results. Q2 Are you:  Please select ONE only.   Male Female Q3 Your age group:  Please select ONE only.   18 - 24 years 25 - 29 years 30 - 39 years 40 - 49 years 50 - 59 years 60 - 64 years 65 - 74 years 75 years or over Q4 What is your ethinc group?  Please select ONE only.   White - British White - Irish White - Other white Mixed ethnic group Asian or Asian British Black or Black British Chinese or other ethnic group Q5 Do any of the following disabilities restrict your daily activities?  Please select ALL that apply.   Impaired hearing Poor sight/ blindness Problems with physical mobility Other disability Q6 What is your employment status?  Please select ONE only.   Full-time paid employment Part-time paid employment Self employed Government sponsored training scheme Unemployed Retired Student Not working due to ill health or disability Looking after home and family Voluntary unpaid work Q7 Is your home:  Please select ONE only.   Owned outright Owned with a mortgage or loan Shared ownership Rented from Council Rented from housing association Rented from a private landlord/ letting agent Rented from other Live rent free Q8 Including yourself, how many people are in your household?  Please write the number in each of the boxes below.     Pre-schoool age children     Primary school age children     Secondary school age children     Adults

Taking part in Community Voice Postal surveys will be the main way we ask for views as a Panel member, but here we ask about your interest in other consultation methods we may use.  Please note that your participation in any survey or consultation will always be optional. Q9 Please indicate below which types of consultation you might be willing to take part in.     Yes   No     Online/ telephone self completion survey       Personal face-to-face interview, at a pre-arranged time       Telephone interview, at a pre-arranged time       A group discussion with other Panel members   Q10 Cumbria Constabulary also issues surveys to Panel members on specific Police issues - usually up to 4 surveys each year.  Please indicate below if you would be interested in receiving these surveys, in adddition to "core" Panel surveys.   I wish to take part in Police surveys Yes   No

And finally... Q11 Overall, how satisfied or dissatisfied are you with the following public services in your local area?  Please select ONE for EACH service.     Very satisfied   Fairly satisfied   Neither/  Nor   Fairly dissasisfied   Very dissatisfied   Don't know/ Not used service     Cumbria County Council               Your local Borough, District or City Council               Cumbria Police               Health services           THANK YOU FOR YOUR HELP Please click "SUBMIT" below to send us your details.  We will write to you in due course to confirm your membership. ANY QUERIES? Contact Craigforth on freephone 0800 027 2245 or CV@craigforth.co.uk