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Citizens' Panel sign up

You are being invited to complete this sign up form because you have expressed interest in joining the Citizens’ Panel.

This sign up to the Citizens' panel is being undertaken by Ashfield District Council and the Corporate Policy and Performance Service. 

Your participation is entirely voluntary. You may choose not to participate. If you do decide to complete the form and sign up to the panel, you may wish to withdraw at any time. If you decide not to complete this form or if you withdraw from participating at any time, you will not be penalised.

The form will take approximately 5 minutes. Your response will be treated as confidential at all times.

We will keep your personal data confidential. All data is held securely and protected from public access. The data collected by this form will be used by Ashfield District Council for the purpose of consulting with you as a member of the Citizens' Panel. The data collected in this questionnaire will only be kept for as long as necessary. For more information about how the Council uses your data and to learn more about your rights please see our Privacy notice.

If you have any questions about this questionnaire, or want to withdraw from participating, please contact improvement@ashfield.gov.uk. You may also withdraw your participation by completing the form on the Citizens Panel page of our website.

Electronic consent
Clicking on the “agree” button below indicates that:

  • You have read the above information
  • You are voluntarily agreeing to participate in this survey
  • You are at least 16 years of age

Your details
Title






What is your age group?








Please select your gender:






Please select the ethnic group that best describes you:
















Do you consider yourself to have a disability?



What sexual orientation do you consider yourself to be?






What is your employment status?












What is your religion / belief?









Correspondence address
Contact Details
Ashfield District Council is committed to using digital channels, therefore our preference would be to contact panel members via email. If you would prefer to be contacted via post, please tell us below.


How would you like to participate
Please select at least one answer - Select all that apply:


Data protection
Consent for storing submitted data