You can report any issue you feel is unfairly affecting you, your family or the local community here. We cannot guarantee we will act on every issue, but the information you provide will help us identify common problems in your area. The questions in this survey are optional, but the more detail you provide, the better we can understand the issue and its impact.

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* 1. Do you live in Burnley or Pendle?

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* 2. What does this problem relate to?

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* 3. Briefly explain the issue, including the names of any organisations involved.

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* 4. What is the impact of this issue on you, your family or the local community?

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* 5. Is there anything else you would like us to know?

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* 6. Can we contact you, via email, for further feedback? (You will not be contacted for any other purpose than to provide information related to your answers in this survey.)

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