Project Silver

Gender
MaleFemale

Ethnic Origin
English/Welsh/Scottish/Northern Irish/BritishIrishGypsy or Irish TravellerAny other White backgroundWhite and Black CaribbeanWhite and Black AfricanWhite and AsianAny other Mixed/multiple ethnic backgroundIndianPakistaniBangladeshiChineseAny other Asian backgroundCaribbeanAfricanAny other Black/African/Asian backgroundArabAny other ethnic group

Do you or any of your close family work or have worked in the recent past in any of the following professions?

Publicity/Advertising AgenciesCreative and Design Agencies/ConsultanciesDirect Marketing ConsultanciesMedia IndependentsOutdoor Specialists (ie. Poster Advertising)Public RelationsJournalism (TV/Press/Radio)Marketing/Market ResearchSales Promotion AgenciesCorporate Identity CompaniesCharity sectorNone of these

Have you EVER attended a group discussion or depth interview before?

YesNo

Have you been to a group discussion or depth interview in the last 6 months?

YesNo

What was the subject of the discussion group(s)/depths you took part in in the past?

What is your working status?

Full-time (30+ hrs/wk)Part-time (8-29 hrs/wk)Not workingRetiredStudent

SERVICE USER
_________________________________________________________________

Which of the following best describes your living status?

HomeownerRental – privateRental – local authorityOther (Please specify)n/a

Which of the following best describes your living arrangements?

Live with my partner/spouseLive on my ownLive with a friendLive with younger relations e.g. child or niece/nephewn/a

Which of the following best describes your circumstances?

I have children/younger relations who I see oftenI have children/relations who live further away but we are in regular contactI don’t have children or younger relations who live near me or with whom I am in regular contactI don’t have children or any younger relationsn/a

Which of the following are services you have used/considered using or may consider using in the future?
Choose all that apply

Getting some support to check that I am claiming relevant benefits e.g. pensions credits or council tax reliefCalling a helpline for advice on issues related to getting older e.g. financial planning or advice about wellbeingUsing a friendship service e.g. someone to visit me at home or chat to on the phoneRequesting or downloading advice leaflets related to getting older e.g. finances, choosing where to liveOther service (Please specify)I wouldn’t consider getting any help at alln/a

SUPPORTER/DONOR
______________________________________________________________

Which of the following ways do you support charities nowadays?
Choose all that apply

Give collections e.g. person collecting in streetDonated to or made purchase from a charity shopMake one-off donations (via text, phone, online or post)Make regular donations (via direct debit, standing order or payroll giving)Volunteer your timeTake part in sponsored fundraising event (e.g. a marathon, walk)Campaigning action e.g signed an e-petition, written to my MP on behalf of a charity or causeSupported in some other wayI do not support charitiesn/a

Which of the following types of charity do you support?
Choose all that apply

Older peopleAnimalsThe artsChildrenCulture and HeritageEnvironmentalForeign AidMedicalOther (Please specify)n/a

Which of the following types of charity would you NOT consider supporting?
Choose all that apply

Older peopleAnimalsThe artsChildrenCulture and HeritageEnvironmentalForeign AidMedicalOther (Please specify)n/a

Which of the following charities - focused on older people - do you currently support (By support we mean support financially, participate in events, volunteer, or campaign for)?
Choose all that apply

Age UKAge concernCarers UKContact the ElderlyAliveThe SilverlineFriends of the ElderlyThe Stroke AssociationParkinson’s UKDementia UKAlzheimer’s Societyn/a

How would you describe the way you support AGE UK?

1. Financially support/sponsored events2. Volunteer3. Campaign4. Othern/a

Which of the following are issues you are interested in and concerned about?

Animal rightsCare for older peopleThe gap between the rich and the poor in this countryFairness in our societyPrescription chargesFairness in pension creditsCare costs for older peoplePension levels (not keeping pace with inflation)LonelinessIsolation in societyHomelessnessTerrorismThe environmentGlobal warmingn/a

Which of the following services would you consider using, in the future for an older relative?
Choose all that apply

Support to check that my relative is claiming relevant benefits e.g. pensions credits or council tax reliefCalling a helpline for advice on issues related to getting older e.g. financial planning, or advice about wellbeingUsing a friendship service e.g. someone to visit my relative at home or chat to on the phoneRequesting or downloading advice leaflets related to getting older e.g.well being, choosing where to live, financesOther service (Please specify)I wouldn’t consider getting any help at alln/a

______________________________________________________________

Which group would you like to attend?

Group 2: Potential Service User - 6.00pmGroup 3: Potential Supporter/Donor - 7.45pm