What is ViewPoint? ViewPoint is a residents' research panel, from the population of Torbay.

Who can be a member of the Viewpoint Residents Panel? Any Torbay resident, aged 18 and over, can apply to be a member. We would like the panel to reflect the profile of the population of Torbay, for example by age, gender and postcode, so we will ask for these details when you apply.

What would I have to do? If you are accepted onto the panel we will send you a couple of short questionnaires per year to complete. This will give you the opportunity to have your say about the development of services, policy and your local community: Surveys can be completed online or we will send you a copy in the post. Occasionally there are opportunities to take part in focus groups or further research but this is optional.

About You

The data provided will be used to help us understand the views of different groups of people based upon gender, age group and geographical location therefore please ensure these questions are completed in full.  In order to be considered for the panel you must be aged 18 or over and a Torbay resident.

	Title
	Mr		Mrs		Miss		Ms		Dr		Other

	Other title (please specify)

	Your Name
	Forename
	Surname

	Your Home Address
	House Number or Name
	Street Name
	Town
	Postcode (e.g. TQ1 3DR)

	Telephone

	Please provide us with your email address if you would like to receive Viewpoint questionnaires online:

Gender

Male

Female

	What is your date of birth (DD/MM/YYYY)

About You

	Employment status
	Employed full time (30 hours +)
	Employed part time (under 30 hours)
	Self-employed
	On a government supported training programme
	Full time education at school, college or university
	Unemployed
	Sick / disabled
	Retired
	Looking after the home
	Full time carer
	Other

	Please indicate your occupation in the box below: (if you are retired, please state your former occupation)

	Do you have access to a car?
	Yes - 1 car		Yes - 2 or more cars		No car

	How long have you lived in Torquay?
	Under 1 year		11 - 20 years
	1 - 2 years		21 + years
	3 - 5 years		Since birth
	6 - 10 years		Don't know / can't remember

Engaging with our Community

We are keen to include as many points of view as possible, this will enable us to gain an understanding of different community experiences.

	How would you describe your ethnic origin?
	White
	Mixed race
	Asian or Asian British
	Black or Black British
	Chinese or other ethnic group
	Prefer not to say

	White
	British
	Irish
	Any other White background

	Mixed race
	White and Black Caribbean
	White and Black African
	White and Asian
	Any other Mixed background

	Asian or Asian British
	Indian
	Pakistani
	Bangladeshi
	Any other Asian background

	Black or Black British
	Caribbean
	African
	Any other Black background

	Chinese or other ethnic group
	Chinese
	Any other ethnic background

	Please tell us your ethnic background

	If your first language is anything other than English, please tell us what it is in the box below:

	Would you like to take part in consultations looking specifically into the views of people who are from a similar ethnic background as yourself?
	Yes		No

	Do you have any long-standing illness, disability or infirmity? (long standing means anything that has affected you over a period of time or that is likely to affect you over a period of time)
	Yes		No

	Does this illness or disability limit your activities in any way?
	Yes		No

	If your disability or illness does limit your activities, please select below in what way:
	My disability or illness affects my mobility
	My disability or illness affects my hearing
	My disability or illness affects my vision
	My disability or illness affects me in another way

	Please tell us the other way(s) your disability affects you:-

How We Could Engage With You

In addition to completing the Viewpoint questionnaires, there may be opportunities to get involved in other ways.  These would be infrequent and not likely to exceed more than once a year.  Please indicate below if you are interested in any of the following additional ways we could consult with you.

	Small group discussions: Where you take part in group discussions with other panel members on particular council services or issues of the day.
	Yes
	No

	Face-to-face: A representative calls at your home and spends a maximum of half an hour asking questions.
	Yes
	No

	Telephone:  A representative rings you and spends around ten minutes asking questions.
	Yes
	No

	If you are not selected to be part of the panel, may we include your details on our database and contact you about other consultations?
	Yes
	No

Thank you for taking the time to complete this form.  If you have any queries about the Viewpoint panel or would like this form in an alternative format then please contact the Policy, Performance & Review Team on 01803 207227 or email us at consultation@torbay.gov.uk

Please click on the SUBMIT button below to send us your details.

Data Protection: The information you provide on this form will be processed by the Policy, Performance and Community Engagement Team, Torbay Council in accordance with the Data Protection Legislation. Your responses will be stored in a secure electronic database, they will only be used to assist in the analysis of opinion, and will not be kept for longer than 5 years. It may also be disclosed to other departments within the Council for such purposes. For further information about how we handle your personal data and your information rights please visit our website.