About my household

We are asking for your views on our community. As a resident of Cleobury Mortimer, you know its strengths and weaknesses. We want to know what you think.

We are writing a Neighbourhood Plan for Cleobury Mortimer. This will enable us to have a more direct influence on planning decisions that affect our parish. In order to do this, we need to understand what our community wants and needs. That is why we are asking you to complete this survey.

The first part of the survey is to learn about the person who is completing it. Please answer the first set of questions as it describes you personally

Confidentiality
· Your response to this survey is totally confidential – the form does not contain any information that identifies you personally
· There is no way of linking it to your specific address
· If you have any questions about the survey, please contact the team at survey@cleobury.org.uk

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* 1. Do you currently live in Cleobury Mortimer?

* 2. If you do not currently live in Cleobury Mortimer, tick any of the following that are true for you:

* 3. My age is:

* 4. The family members in my household are this old (add the number for each age group)

  1 2 3 4 5
Age 11 or younger
11-18
19-29
30-49
49-65
Over 65

* 5. The category that best describes where I live is:

* 6. The building I live in is best described as:

* 7. I have this many bedrooms in my house:

* 8. My employment status is best described as:

* 9. My type of work is best described as:

* 10. The employment status of other people in my household is best described as:

  2nd person 3rd person 4th person 5th person
Full-time employed
Part-time employed
Self-employed
Unemployed
Student
Retired

* 11. My place of work (if relevant) is:

* 12. I consider my personal health to be:

* 13. My favourite thing about Cleobury Mortimer is:

* 14. My least favourite thing about Cleobury Mortimer is:

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