Hounslow Citizens' Jury

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Thank you for your interest in joining the Citizens' Jury on how Hounslow Council should engage and consult residents in its decision making.

The purpose of this survey is to make sure that the Jury is reflective of the people that live in Hounslow. The information is being collected by Involve, an independent public participation charity running the Citizens' Jury on behalf of Hounslow Council. Your personal data will not be shared with the council or with any other third parties.

What is your first name? *

What is your surname? *

What is your phone number?

Please make sure your contact details are correct, or we will not be able to get in touch if you are selected.

What is your email?

Please make sure your contact details are correct, or we will not be able to get in touch if you are selected.

What is your postcode?

We want to make sure that the Jury members live in different parts of Hounslow.

How would you describe your gender? *

Female

Male

Other:

How old are you? *

18-25

26-40

41-55

56-70

Over 70

How would you describe your faith? *

No religion

Christian

Buddhist

Hindu

Jewish

Muslim

Sikh

Other:

How would you describe your ethnicity? *

Asian, Asian British or Asian Welsh

Black, Black British, Black Welsh, Caribbean or African

White British

White other

Other:

How would you describe your sexuality? *

Bisexual

Gay or lesbian

Heterosexual or straight

Other:

Would you describe yourself as disabled? *

Yes

Other:

What is your highest educational qualification? *

Degree equivalent or above (for example, university degree, BTEC Higher level, NVQ level 4, teaching or nursing)

A level equivalent (for example, A Level, BTEC National, or NVQ level 3)

GCSE equivalent (for example, GCSE, BTEC General Diploma, or NVQ level 2)

No formal qualifications

Other:

Which statement best describes how often you get in touch with the council? This could include contacting them about services you use or about local issues that you are interested in, or something else.

We want to make sure that Jury members have a range of experiences of contact with the council.

I regularly get in touch with the council (e.g. every three months or more frequently)

I sometimes get in touch with the council (e.g. once or twice in the last year)

I rarely get in touch with the council (e.g. once or twice in the last five years)

I have never been in touch with the council

If you are selected to take part in the Jury, Involve will need to contact you about the next steps. Are you are happy for Involve to save the information you have given in this survey, and for their team to contact you if you are selected to take part? *

Yes

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