We currently have a "Citizens' Panel" for adults. This panel receives surveys on a regular basis sent out by the council on a variety of subjects. We are looking at setting up a similar panel for 11-18 year olds. They will be sent many of the questionnaires that the adults are sent, and we would use the results to see just how views differ. There will be a maximum of 10-15 surveys a year and you can receive them either by email or by post.   We are doing this to ensure that we are doing all we can to listen to your views. You will be informed of the results of the surveys via a newsletter and be told afterwards what the Council is doing to try and change things. There will also be a section on our website for the Youth Citizens' Panel. If you are interested in joining, please complete this survey.

Q1	What is your full name?

Q2	What is your gender?
		Male		Female

Q3	Would you prefer to be contacted with single surveys when they are ready or a group of surveys a few times a year?
		Single		Group

Q4	What is your date of birth?

Q5	What year are you in at school?
		Year 6		Year 9		Year 12
		Year 7		Year 10		Year 13
		Year 8		Year 11		Not in school

Q6	We will be regularly sending out a newsletter of results, have you got any comments on what you would like this to feature and how often you would like to receive it?

Q7	We are currently refreshing the Consultation section of the Wokingham website. Is there anything that you would like to see on this?

Q8	Do you think that the Youth Citizens' Panel should have a name? If yes have you got any ideas what it could be called?

Q9	Would you like to receive email surveys to complete online or surveys by post?
		Email		Post

	Please enter your email address or full postal address depending on which way you would like to receive the surveys

Q10	Which area of the Wokingham Borough do you live in?
		Wokingham/Winnersh/Finchampstead/Emmbrook
		Earley/Shinfield/Arborfield/Spencers Wood/Swallowfield
		Woodley/Twyford/Hurst/Wargrave/Charvil/Sonning

Q11	Do you consider yourself to have a disability or long standing illness?
		Yes		No		Prefer not to say

Q12	To which of these groups do you consider you belong?
		a) White (British, Irish, Traveller of Irish Heritage, Gypsy/Roma, any other white background)		e) Chinese
		b) Mixed (White and Black Carribean, White and Black African, White and Asian, any other mixed background)		f) Any other ethnic group, please state below
		c) Asian or Asian British (Indian, Pakistani, Bangladeshi, any other Asian background)		Prefer not to answer
		d) Black or Black British (Caribbean, African or other Black background)

Other

Q13	Which religious faith do you belong to?
		None		Jewish
		Christian (including Church of England, Catholic, Protestant and all other Christian denominations)		Muslim
		Budhist		Sikh
		Hindu

Many thanks for completing this survey. If you have any questions please contact Carla Tanswell on carla.tanswell@wokingham.gov.uk or by phone 0118 9088229