Customer Influence Panel Application If you need any assistance completing this form or would like it in a different format, please contact the Customer Engagement Team. Personal information Last name First name(s) Preferred name (if different) Title (Dr/Mr/Mrs/Miss/Ms/Other – please specify) Address Start typing your address in the postcode field Preferred phone number Email address * Key strengths and behaviours The Customer Influence Panel values individuals who are reflective, strategic, and committed to working collaboratively. Please tick up to four qualities that best describe you: Strategic thinker Constructive challenger Good communicator Team player Actively listens to others Interested in improving services Uses lived or professional experience to inform views Committed to equality, diversity, and inclusion Willing to learn and develop Dependable and consistent Knowledge and experience Please tick the areas where you have experience, insight or interest. We welcome a range of lived, voluntary and/or professional experience: Repairs and property services Housing management or tenancy experience Customer complaints and feedback Diversity, inclusion and fair access Service design or improvement Governance or performance monitoring Tenant involvement or scrutiny Data or digital services Social care or support services Environmental or community issues Leaseholder experience Other Other Please state Tell us about you Why are you interested in joining the Customer Influence Panel? (For example, what motivates you, what you'd like to achieve, or why you think your voice matters.) What skills, experience or knowledge would you bring to the panel? * (This might include work, volunteering, or life experience – everything counts.) Declaration Are you related to, or do you know, any staff member or Board Member of Amplius? Yes No If yes, please give details: Are you a staff member or Board Member of another housing provider? Yes No If yes, please give details: Support needs Do you require any support, adjustments or equipment to help you participate in meetings (for example large print, travel support, hearing loop, digital access)? Yes No If yes, please give details: Consent and Data Protection The information you provide will be stored securely and only used for recruitment and panel-related communication in line with data protection regulations. I confirm the information provided is accurate to the best of my knowledge. I agree Captcha Help us fight spam.
