Leeds Involving People Membership Survey

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* 1. What is your name?

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* 2. What is your gender?

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* 3. What is your ethnicity?

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* 4. What is your phone number?

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* 5. What is your email address?

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* 6. What is your address?

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* 7. What is your postcode?

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* 8. Do you represent an organisation? Please state:

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* 9. Do you have any access needs? Please state what they are:

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* 10. How would you prefer us to contact you?

Telephone call

Text message

Post

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* 11. If you have chosen telephone call, what time of day would you prefer us to contact you?

Morning

Afternoon

Evening

Not applicable

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* 12. If you have chosen telephone call, which day would you prefer us to contact you?

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

Not applicable

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* 13. Which projects are you interested in?

Better Lives Board - The Better Lives Board was formed to provide community leadership for care and support services in Leeds.

Together We Can - Together We Can is LIP’s lived experience mental health network. Feedback from members is passed on to mental health service providers across the city and helps to influence decision making and the way that services are designed and delivered.

Forum for Race Equality in Social Care and Health - This is a vibrant group made up of diverse communities and members working in partnership to influence Leeds City Council Adults and Health Directorate and NHS Leeds CCG.

Visible Reference Group - The aim of this group is to improve health and well-being services for those who have experienced CSA. The project is to consider training for professionals on early identification and sensitivities when working in this particular area.

Leeds DEAForum - The Deaforum aims to make sure deaf people’s views and concerns are met by Leeds City Council Adult Social Care, and train deaf people and providers to work together more effectively.

The Listening Project - Leeds City Council Adult Social Care would like to know how they can improve access, care and support services to people from Black, Asian and Minority Ethnic Communities in Leeds.

Connecting Leeds - LIP is the engagement partner for Connecting Leeds, working to ensure people are involved in decisions about transforming travel in Leeds for people who live, work in and visit the city.

Mental Health Transformation - The Community Mental Health Transformation Programme is a partnership of NHS organisations, community and voluntary sector, Social Care and service users/people with lived experience coming together to transform how primary and community mental health services are currently organised and delivered for adults and older adults with serious mental illness and complex needs.

The Equipment and Telecare Service User Group - The group encourages service users to raise any issues they encounter with items supplied by Leeds Community Equipment Services with the aim of finding ways to resolve them. TETSUG members also provide feedback to technicians who are developing new technology and products.

Training - We deliver a vibrant and wide range of different training courses, from Winter Wellbeing to Managing Anxiety.

I am interested in receiving the newsletter and other general information.

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* 14. Please tick the box below giving us permission to use the information you have supplied in the following ways:

· To store it securely for membership purposes.

· To communicate with you as a Leeds Involving People member.

· To share with Group/Project Coordinators for those groups/projects that you are a member of/have expressed interest in.

· To send you general information about Leeds Involving People.

Yes

Please be advised that you can request for your data not to be used for any of these purposes at any time by contacting us at info@leedsinvolvement.org.uk / 0113 237 4508

Please be assured that your data will not be used for marketing purposes or passed on to third parties.

Leeds Involving People Membership

Membership Updates

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* 1. What is your name?

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* 2. What is your gender?

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* 3. What is your ethnicity?

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* 4. What is your phone number?

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* 5. What is your email address?

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* 6. What is your address?

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* 7. What is your postcode?

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* 8. Do you represent an organisation? Please state:

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* 9. Do you have any access needs? Please state what they are:

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* 10. How would you prefer us to contact you?

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* 11. If you have chosen telephone call, what time of day would you prefer us to contact you?

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* 12. If you have chosen telephone call, which day would you prefer us to contact you?

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* 13. Which projects are you interested in?

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