APPLICATION TO BECOME A MEMBER OF THE by dfhrf555fcg

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									     YOUR VIEWS OF THE CAERPHILLY COUNTY BOROUGH VIEWPOINT PANEL
    BEING PART OF THE CAERPHILLY VIEWPOINT PANEL
    1.        Please tell us why you chose to join the Viewpoint Panel (VPP):
                      I am generally interested in local matters
                            I wanted to influence change locally
         I wanted to find out more about what the Council does
                                          Other - please write in:
    2.        How strongly do you agree or disagree with the following statements about being a
              member of the Viewpoint Panel?
                                                       Agree    Agree     Disagree  Disagree    Don’t
                                                      strongly                       strongly   know
                Taking part in the VPP is interesting
                           I am committed to the VPP
 The VPP has given me an opportunity to influence
           decisions made about council services
                     The VPP is a waste of resources
 The VPP has given me an opportunity to influence
decisions made about services provided by partner
       organisations e.g. local health board, police
          Things don’t change as a result of the VPP
               I am kept informed about the results of
                   surveys and meetings that I attend
I am kept informed about how these results have an
                          effect on decisions made
                           The VPP is a waste of time
          Overall, I enjoy being a member of the VPP
    3.       How long do you think people should stay on the Viewpoint Panel?
          1 year       2-3 years           4-5 years          More than 5 years
    QUESTIONNAIRE SURVEYS
    4.       What is the maximum number of questionnaires you would be happy to complete
             within one year?
             1-2              3-4             5-6                More than 6
    5.       How strongly do you agree or disagree with the following statements about the
             Viewpoint Panel questionnaires that you are sent?
                                                     Agree   Agree   Disagree   Disagree     Don’t
                                                    strongly                     strongly    know
             The questionnaires are easy to fill in
                  The questionnaires are too long
           I only complete the questionnaire if I’m
                            interested in the topic
    I receive too many questionnaires in a year
         The time allowed to respond (2 weeks) is
                                        too short
          The questionnaires are too complicated
              More background information would
             help me complete the questionnaires
           Overall, I enjoy filling in questionnaires
     VIEWPOINT PANEL MEETINGS
     6.       What is the maximum number of meetings you would be happy to attend within one
              year?
                  None          1-2          3-4            5-6       More than 6
     7.      If you haven’t attended meetings in the past, why not?
    Lack of transport               Childcare         Caring for another person               Lack of time
  Lack of confidence           Time of meetings                         Long-standing illness or disability
      Not interested               Other reason           Please write in:
     8.       What, if anything, would encourage you to attend (more) Viewpoint Panel meetings?
                      Invites are sent well in advance
           Consultations are targeted to your interests
More background information is provided in advance
                          Meetings are held in the day
                     Meetings are held in the evening
          If meetings are held closer to where you live
                                 Transport is provided
                            The venues are accessible
     Provision is made for my specific requirements            Please give details:
                    e.g. dietary, disability, language
                      Something else - please write in
     WHAT YOU ARE MOST INTERESTED IN BEING CONSULTED ON
     The Panel is consulted on a wide range of issues and we want to know if we are consulting on
     things that really concern or interest you so that we can target our consultations to suit you.
     9.       Listed below are the key priorities/areas within the Council. Please tick the areas
              that are of most interest/concern to you:
               Please consult with me on ALL areas     Environment and planning
                                 Advice and benefits      Health and social care
                                           Business       Housing
                               Community and living       Jobs and careers
                             Council and democracy        Leisure and tourism
                             Education and learning       Travel and transport
     10.      Are there any other issues that you would like to be consulted on in the future?
              Please write in:




     ABOUT YOU
     The following questions will help us to make sure that the Viewpoint Panel represents all
     residents in the Caerphilly County Borough area.
     11.         Are you:        Male              Female
     12.     In which year were you born? Please write in
     13.      To what level, if at all, do you speak Welsh?
           Do not speak Welsh at all            Speak Welsh fluently             Can converse in Welsh
14.        Which of the following, if any, does your household have? Please tick all that apply.
                                            Yes    No
           Personal Computer (PC) at home
              Access to the Internet at home
15.        Which of these activities best describes your current employment position? Please
           tick one box only (Please only tick ‘looking after the home’ if this is your main
           activity and none of the other options apply)
             Employee in full-time job (30 hours plus)               Permanently sick/disabled
      Employee in part-time job (under 30 hours)                          Wholly retired from work
                      Self-employed full or part-time                        Looking after the home
On a government supported training programme                                    Full-time education
    (e.g. Modern Apprenticeship, New Deal etc)
                   Unemployed & available for work          Doing something else - please write in:


16.    What is/was your occupation? Please write in
17.        Do you have a long standing illness, disability or infirmity? (Long standing means
           anything that has troubled you over a period of time or that is likely to affect you
           over a period of time.)
                                        Yes              No
18.        Does this illness or disability limit your activity in any way?
                                           Yes              No
19.     Which of the following best describes your ethnic origin?
White
   British
     Welsh
      English
      Scottish
      Other                                      Please write in:
   Irish
   Any other white background                    Please write in:
Mixed, Mixed British (English, Scottish, Welsh)
   White and Black Caribbean
   White and Black African
   White and Asian
   Any other mixed background                    Please write in:
Asian, Asian British (English, Scottish, Welsh)
   Indian
   Pakistani
   Bangladeshi
   Any other Asian background                    Please write in:
Black, Black British (English, Scottish, Welsh)
   Caribbean
   African
   Any other black background                    Please write in:
Chinese, Chinese British (English, Scottish, Welsh)
  Chinese                                     Please write in:
Other Ethnic Group                               Please write in:
20.   Which of the following best describes your household?
                                  Single person
            Single parent, with dependent children
                                        Adult couple
                Adult couple, with dependent children
       Group of adults, either related or unrelated,
                                    without children
          Group of adults with dependent children
                                               Other         Please write in:
21.     Which of the following best fits your current housing circumstances?
                  Renting from Council                                    Owned outright
      Renting from Housing Association                                         Owned with mortgage
                          Renting privately                                           Tied housing
Shared Ownership (Part owned/rented)               Other, please write in

KEEPING IN TOUCH WITH YOU
22.     Please provide us with your correct contact details below:
        Title:                     Name:
  Address:




Telephone:
      E-mail:

23.     In the future, how would you prefer to receive questionnaires?
                            A paper copy by post             Via e-mail

24.     How would you most like us to let you know about the results from the surveys and
        meetings that you take part in?
        Receiving a short report through the post
                                      Via ‘Newsline’
                    On the Caerphilly CBC Web site
                               Via a VPP newsletter
          I’m not interested in hearing the results
                                              Other         Please write in:

25.     Would you like to receive future correspondence in English, Welsh or in both
        languages?
                           English            Welsh                In both English and Welsh

 Thank you very much for your involvement as a member of the Caerphilly County
 Borough Viewpoint Panel. All personal information will be treated confidentially.

								
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