Fife People's Panel registration form

Name

First name (Required)

Surname (Required)

Address

House number/name (Required)

Street name (Required)

Village/Town (Required)

Postcode (Required)

Date of birth

(Required)

Day (dd)
-

Month (mm)
-

Year (yyyy)

Gender

(Required) Male Female Non-binary Prefer to self-describe Prefer not to say

Would you be happy to complete surveys online?

Sending out information by email helps us keep financial and environmental costs down. However, we understand that completing surveys online isn't possible for all panel members, therefore please select below how you would prefer to receive information on consultations.

(Required) By email By post/paper

Email address

We require this to send you surveys by email if this is your preference, and it is also useful for us to ensure your details are kept up-to-date.

What is your ethnic background?

(Required) White Scottish Other White British Other White background African, African Scottish or African British Asian, Asian Scottish, or Asian British Black, Black Scottish or Black British Caribbean, Caribbean Scottish or Caribbean British Mixed or multiple ethnic background Other ethnic background Prefer not to say

Do you consider yourself to be disabled?

(Required) Yes No Prefer not to say

Do you have any health problems that have lasted or are likely to last for more than 12 months, that have a direct impact on your life?

(Required) Yes No Prefer not to say

Do you care for a family member, friend or neighbour due to their illness or disability?

(Required) Yes No Prefer not to say

Your household

Which of the following categories best describes your household?

(Required) Single person under pension age Single over pension age Couple over pension age Couple without children Couple with children Lone parent family Other

If you have children under 16 in your household, which age group(s) are they in?

Pre-school Primary school Secondary school

Which of the following categories best describes your household's accommodation?

(Required) Owner-occupied Rented - Fife Council Rented - housing association Rented - privately Student accommodation Other

Employment status

Of the following categories, which one best describes your current employment status?

(Required) Employed - less than 30 hrs/wk Employed - 30 hrs/wk or more Self-employed (part-time or full-time) Government training scheme Unemployed and seeking work In further/higher education Looking after home/family Permanently retired from work Permanently sick/disabled Other

Please tell us where you heard about the People's Panel

Internet search Fife Council website Our.fife.scot website Other survey Social media Family/friend Other (please give details)

Other source

You are about to submit your response. By clicking 'Submit Response' you give us permission to use your information for the purposes of managing the membership of the panel and informing members of consultations. After you click Submit Response, you will no longer be able to go back and change any of your answers.

Registration details