Thank you for joining the Society Cornwall Community Panel! If you have reached this page then you have successfully confirmed your registration with Society Cornwall.  There is just one more small yet very important step for you to take: We now need you to complete this short Induction Survey, which should take you just 3 or 4 minutes to complete.  This will help us to learn a little bit more about you and make sure we are properly representing the full diversity of communities in Cornwall. If you have any questions at this stage or are unsure about anything, please get in touch.  All our contact details are on the Society Cornwall web site. Thank you!

Please click on the NEXT button below to start.

About You

First of all, which of the following best describes your current situation?
	Employed full-time (30 hours/week or more)		Unemployed and unavailable for work
	Employed part-time (under 30 hours/week)		Permanently sick or disabled
	Self Employed, full or part time		Retired from work
	Full-time education		Looking after the home
	Unemployed, actively seeking work		Doing something else

	You said you are doing something else...could you please briefly describe what you are doing at present:

Do you have a limiting long term illness, health problem or disability which limits your daily activity or the work you are able to do?

Yes

No

Don't know

About You

How do you describe your ethnic origin?

White
	English, Welsh, Scottish, Northern Irish, British
	Irish
	White Cornish
	Other White background - Please state:

Mixed
	White and Asian
	White and Black Caribbean
	White and Black African
	Mixed Cornish
	Other Mixed background - Please state:

Black
	African
	Caribbean
	Black Cornish
	Other Black background - Please state:

Asian
	Bangladeshi
	Pakistani
	Chinese
	Indian
	Asian Cornish
	Other Asian background - Please state:

Other
	Gypsy / Roma
	Traveller of Irish Heritage
	Other background - Please state:

Prefer not to say

About Your Household

How many people of the following age groups permanently live in your household? (Please write the number in each relevant box)
	Males aged 18 and over
	Females aged 18 and over

How many people of the following age groups permanently live in your household?
	Males or females aged 16 to 17
	Males or female children aged 11 to 15
	Males or female children aged 10 and under

About Your Household

Do you...?
	own your home without a mortgage		have shared ownership of your home
	own your home with a mortgage		live in residential care / nursing home
	rent from a social landlord		live in sheltered accommodation
	rent from the council		live with family / friends
	rent from a private landlord		Other

	You said you have other living arrangements...could you please briefly describe them below:

What is the combined gross annual income of your household?  (Gross income refers to the income received before payment of tax.)
	Up to £14,999 per annum		£55,000 to £59,999 per annum
	£15,000 to £24,999 per annum		£100,000 or more per annum
	£25,000 to £39,999 per annum		Don't know / Do not wish to say
	£40,000 to £54,999 per annum

Community Involvement

Which, if any, of the following roles do you currently hold?
	School governor		Member of a Parent Teacher Association
	Parish councillor		Neighbourhood Watch committee member
	Town councillor		Magistrate
	District councillor		Citizen Advice Bureau advisor
	County councillor		Other Local community committee
	Member of a church committee		None of the above

	You said you are a member of an 'other local community committee'... please describe the local community committee:

Community Involvement

Do you actively participate in any voluntary or community groups on a regular basis? Please do not count any voluntary or community group activity you do in connection with your employment.

Yes

No

On average over the last 12 months, how many hours per week have you volunteered to help out a charity or a community group? (Please enter number of hours per week. If you are unsure, please provide your best estimate.)

Community Involvement

Do you give regular unpaid care to someone who is disabled, ill or frail (including children with special needs)? Please do not include any caring activities you undertake for which you receive any form of payment, including State benefit payments (e.g. Carers Allowance)

Yes

No

On average over the last 12 months, how many hours per week do you provide unpaid care for someone who is disabled, ill or frail? (Please enter number of hours per week. If you are unsure, please provide your best estimate.)

Thank you

Thank you - that's the end of the Induction Survey. Before you submit your answers, please could you tell us where you heard about Society Cornwall?
	Picked up a leaflet
	Received an email
	Word of mouth
	Roadshow event
	Community event or local agricultural show
	Newspaper article or advert
	Radio feature
	Or ... somewhere else?

	You said 'somewhere else'... please describe:

Thank you for completing your Society Cornwall Induction Survey. Make sure you click on the SUBMIT button below to send us your answers.