* 1. About you:
Which Estate do you live on?

* 2. What age are you?

* 3. Do you have children under 18 living with you at home?

* 4. Do you have a disability?

* 5. Are you a carer?

* 6. Do you have access to a car?

* 7. What services do you or your family make use of now? Many of these (but not all) will be provided by the community or city council? Tick all that apply.

* 8. Which of the services in the questions above are most important to you? Please choose five

* 9. Are there any services in the question above that you would not miss or would not mind if less was provided?

* 10. How much do you agree or disagree with the following statements (1 = Agree Strongly, 5 = Disagree Strongly)

  1 2 3 4 5
Maintaining the landscape in our areas is very important
Keeping the streets clear of litter is very important
Providing youth clubs etc for children and young people is important
Tackling Crime and promoting community safety is important
Providing a good bus service is important
Looking after the elderly and disabled in our community is important
Providing help and advice on a wide range of issues is important
Providing services for parents and young children is important

* 11. What are the top 3 Things that would help improve your area and/or your community?

* 12. What services or facility that is not currently provided locally would you like to see? (As many as you wish)

* 13. Finally if you wish (You don't have to fill this section if you do not wish to)

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