In this section
Consultation
Citizens Panel
Past Consultations
If you are interested in taking part in future consultations, please complete the form below.
All the information you provide will be kept confidential and will be used for research purposes only.
Title
Surname
First name
Address
Postcode
Where do you live?
Gateshead
Newcastle
North Tyneside
Sunderland
Northumberland
South Tyneside
Daytime telephone
Evening telephone
Mobile telephone
E-mail address
We may wish to occasionally contact you by telephone or e-mail. Please tick the appropriate box if you are happy for us to do this.
Daytime number Evening number Mobile E-mail
Are you?
Male Female
What is your date of birth?
How old are you?
Under 16 17 - 32 33 - 48 49 - 64 65 +
What is your employment status? Employed full-time Employed part-time Self-employed Ill health Unemployed Retired Houseperson Student Government Training Scheme Other
What is your occupation?
If you are retired please put retired and then your previous occupation.
How would you describe your religious group?
None Buddhist Christian Hindu Jewish Muslim Sikh Do not wish to say Other
How would you describe your ethnic origin?
Indian Pakistani Bangladeshi Any other Asian background Caribbean African Any other Black background Chinese White and Black Caribbean White and Black African White and Asian Any other mixed background British Irish Any other White background Other Ethnic Background Do not wish to say
Do you consider yourself to have a disability?
No Yes, affects mobility Yes, affects hearing Yes, affects vision Other
Do you have a disability as defined in the Disability Discrimination Act 1985?
"A physical or mental impairment which has a substantial and long-term adverse effect on a persons ability to carry out normal day to day activities."
Yes No
Would you prefer future correspondence to be:
In another language - if so, which?
In large print Other
We have mentioned in the document headed "About Northumbria Police Authority" that as part of our future consultation we may ask you to complete questionnaires or take part in focus groups. Please indicate below what your preference would be:
Complete questionnaires only Attend focus groups only A mixture of both
