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Virtual Citizens' Panel application form

This form is for people who wish to register as new members of our Virtual Citizens' Panel. To qualify you must be aged 16 or over and live in Charnwood. Borough councillors are not allowed to join the panel because of the possible conflict of interests.

You will notice that this form contains some monitoring questions that we ask in order to comply with requirements of The Public Sector Equality Duty as outlined in The Equality Act 2010. 

We stress as a public body that it is important for us to gather this information to ensure we provide facilities and services that meet the needs and expectations of all sectors of the community, however there is a 'Prefer not to say' option if you feel uncomfortable answering any of the questions.

If you have any questions about the Citizens' Panel or the form please contact us on:

Please complete as much information as possible on this form. Some fields are mandatory, so must be completed. They are marked with an asterisk.


Data protection

We may also use this information within the council to exercise functions of a public nature in the public interest; it will not be used outside of the council.  

Getting in touch with you

Please tell us how we can contact you about the Citizens' Panel

About you

These answers will be kept confidential and used to help us see if different groups of people have different experiences and views.

Equal Opportunities

The information provided will be treated in the strictest confidence and will only be used to monitor take up of services and ensure that no particular individual or group of people are discriminated against in the provision of services or employment opportunities. This monitoring information could be passed onto other services of the Council, who need to use it for the same purpose. Any answer you give will not affect the service you are receiving from the Council. Thank you for your assistance.

What is your date of birth? * / /
About your household
About your interests

As well as the consultation we will be sending to everyone on the panel, we may ask panel members with particular interests to take part in surveys and discussion groups.

Please tick any areas that especially interest you:

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