The Faith Network Mapping provision for people and families in need Thank you for taking the time to complete this survey. OK Question Title * 1. What is the name of your organisation? OK Question Title * 2. Please enter the address of your centre: * OK Question Title * 3. Please enter the postcode of your center: OK Question Title * 4. Please fill out the Primary Contact information: Name of Primary Contact: Email Address: Phone Number: Website Link (if you have one): OK Question Title * 5. Are you a faith based group? Yes No Other Organisation: OK Question Title * 6. About your place of worship, organisation or group. Is your organisation best described as... * Place of worship Faith based organisation OK Question Title * 7. Which faith tradition does your place of worship, organisation or group represent? * Alevism Buddhism Christianity Hinduism Islam Judaism Rastafarianism Sikhism Other (please specify) OK Question Title * 8. What language(s) is your service available in? English Albanian Amharic Arabic Bengali Bosnian Cyrillic Bosnian Latin Chinese Chinese (simplified) Croatian Czech Dari Dutch Farsi Filipino French Gujarati Hebrew Hindi Hungarian Italian Japanese Korean Kurdish-Bahdini Kurdish-Kurmanji Kurdish-Sorani Lingala Lithuanian Polish Portuguese Punjabi Pushto Romanian Russian Serbian Slovak Somali Spanish Swahili Tamil Tigrinya Turkish Urdu Welsh Yoruba Yiddish Other (please specify) OK Question Title * 9. Please state your email. (We will keep your email on our database - this will be viewed by Hackney CVS staff and volunteers working on the faith network, but will not be shared with any other parties.) OK Question Title * 10. Do you provide any of the following services for free or low cost? Check all that apply. Free Charge Food Food Free Food Charge Clothing Clothing Free Clothing Charge Shelter Shelter Free Shelter Charge OK Question Title * 11. Please explain the nature of the services provided in relation to food, shelter or clothing. * OK Question Title * 12. Do you provide any other relevant services? Please specify what that might be. * OK Question Title * 13. What geographic areas do the services cover? OK Question Title * 14. Is your service referral only? * Yes No OK Question Title * 15. If yes, what is the referral procedure? OK Question Title * 16. Please tell us the days and times when your service is open and what is provided at these times. * OK Question Title * 17. What is the average number of people attending or receiving help each time? * OK Question Title * 18. Do you have a working partnership with any of the following? * Local Authority NHS GP Police Another faith group Another voluntary sector group No partnership with any of the above Other (please specify) OK Question Title * 19. Is there any support you need or help to do these activities? * OK Question Title * 20. Is your building accessible. Please describe below: OK Question Title * 21. Would you like to receive information from the faith network on training and events? Yes No OK Question Title * 22. Can we publicise details of your service in a directory? * Yes No OK NEXT
