Viewpoint Application Form

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The Viewpoint Panel and Data Protection Your participation in the Viewpoint Panel and your views are very important to us. We process your information in accordance with the principles set out in the Data Protection Act 2018. Stockton-On-Tees Borough Council will use the information you have provided to maintain an up-to-date panel of residents willing to receive surveys and consultations. We record people's personal information for the purpose of ensuring the panel is representative and also to allow for analysis of the data by respondents’ characteristics. We are processing your personal data with your consent, and we will retain information for a period of three years or the length you are a member of the panel. You have the right to withdraw your consent at any time, please contact viewpoint@stockton.gov.uk. For more information on about your information and data protection, please go to: https://www.stockton.gov.uk/dataprivacy

(Required) I agree to the above statement

What is your title?

(Required) Ms Miss Mrs Mr Rev Dr Prof

Your first name

(Required)

Your surname

(Required)

Please tell us the first line of your postal address (including house or building number and/or name)

(Required)

Town/Village

(Required)

Borough

(Required)

Postcode

(Required)

Preferred contact telephone number including area code (please do not leave a space).

(Required)

Email address

(Required)

Are you male or female?

(Required) Male Female Prefer not to say

What is your sexual orientation?

(Required) Bisexual Gay/Lesbian Heterosexual/Straight Prefer not to say

Please state your date of birth (dd/mm/yyyy):

(Required)

Day (dd)
-

Month (mm)
-

Year (yyyy)

Please select from the following options

(Required) Asian/Asian British - Bangladeshi Asian/Asian British - Chinese Asian/Asian British - Indian Asian/Asian British - Pakistani Asian/Asian British - Any other Asian background Black/African/Caribbean/Black British - African Black/African/Caribbean/Black British - Caribbean Black/African/Caribbean/Black British - Any other Black/Black British background Mixed/Multiple ethnic group - White and Black Caribbean Mixed/Multiple ethnic group - White and Black African Mixed/Multiple ethnic - White and Asian Mixed/Multiple ethnic groups - Any other Mixed/Multiple ethnic background White - English/Welsh/Scottish/Northern Irish/British White - Irish White - Gypsy or Irish Traveller White - Any other White background Other ethnic group - Arab Other - Any other ethnic background Prefer not to say

Do you consider yourself to be a person with a disability as described by the Equality Act 2010?

(Required) Yes No Prefer not to say

What is your current employment status?

(Required) Full time education (at school, college or university) Full time employee (30 hours or more per week) Apprentice Looking after the home/house person Part time employee (less than 30 hours per week) Permanently sick/disabled Self-employed (full or part time) Unemployed Retired Doing something else

Do you work for Stockton Borough Council?

(Required) Yes No