First Name

Last Name

Email Address

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Which of the below describes you? Which of the below describes you? Woman Man Non-binary Prefer to self describe I prefer not to say

What is your main childcare/early years role at the moment? What is your main childcare/early years role at the moment? Registered childminder Childminder assistant Childminder without domestic premises Nanny Childcare on Domestic Premises

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Are you a Coram PACEY member? Are you a Coram PACEY member? Yes No

(Childminder only) Are you registered with Ofsted/CIW or a childminding agency? (Childminder only) Are you registered with Ofsted/CIW or a childminding agency? Ofsted/CIW Childminding agency

What year did you start this role?

Please select your age bracket Please select your age bracket18-24 years25-34 years35-44 years45-54 years55-64 years65+ years

In which region are you based? In which region are you based? England - South EastEngland - South WestEngland - East of EnglandEngland - LondonEngland - East MidlandsEngland - West MidlandsEngland - Yorkshire and HumberEngland - North WestEngland - North EastWales - NorthWales – South

How would you describe the area in which you work? How would you describe the area in which you work? Mostly rural Mostly urban

Please tick any of the below statements that apply to you Please tick any of the below statements that apply to you I provide wraparound care I care for early years children I provide school holiday care I care for children with SEND/ALN I employ assistants/work with other childminders I spend some time working in non-domestic premises I work entirely in non-domestic premises I care for a relative (not my own child) I care for my own children I mentor other providers I’ve chosen not to offer funded early years places

Do you have any specific pedagogical approaches or interests?

Do you have any specialisms (i.e. SEND, ALN or other specific training)?

Would you like to join our private Facebook group for Coram PACEY’s Insight Panel? To invite you, we need to confirm the email address you use for your Facebook account. Would you like to join our private Facebook group for Coram PACEY’s Insight Panel? To invite you, we need to confirm the email address you use for your Facebook account. Yes – send the request to my email address I entered earlier Yes – send the request to a different email address (text box) No, I don’t want to be part of the Facebook group.

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Terms and conditions Terms and conditions By ticking this box, I agree to the terms and conditions of joining the panel and agree to be contacted by Coram PACEY