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Residents’ Survey-Win a Free Digital TV set top box
We are putting together a survey of GEARS residents – this will help us running activities and also help with applications for funding for these activities. As an incentive to fill out and return the Survey we are holding a PRIZE DRAW, the first three lucky residents to have their surveys pulled out of the GEARS’ Top Hat will receive a FREE NETGEM DIGITAL SET TOP BOX. So get the form filled out and return it 20 South Bank Road as soon as possible. The names of the three winners will appear in a future GEARS Newsletter. |
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Name:
Address: Postcode:
Phone Number: Mobile: Email: |
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Who lives in your household? (write how many of each)
CHILDREN (0-11 yrs)
YOUNG PEOPLE (12-19 yrs)
ADULTS (20-50 yrs)
OLDER PEOPLE (50+) |
Housing – are you a: (circle the one that applies to you)
Owner Occupier?
Tenant of private landlord?
Tenant of housing association?
If you have circled ‘housing association’ please write which one, e.g. Community 7, Gingerbread
Other: (please say what) |
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What activities do you think GEARS should get involved in? (Circle one or more)
Education and Training Children and Young People’s activities
Open a Community Centre Stopping anti-social behavior (dog fouling etc.)
Social events (Xmas Party/over 50’s/Panto Trip)
Community Safety Community Transport (own a Minibus)
Managing Birchfield Park
Other ideas:
If you currently do not get involved with GEARS or attend meetings, what do you think is stopping you? (circle any that apply to you)
Don’t feel confident Lack of skills Not enough time
Not interested Didn’t know about GEARS
If there are any other reasons you don’t get involved, please write them here:
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Thank you for co-operating in this survey. We hope this information will be used to improve your area. All information will be held in confidence.
Please return your completed surveys to 20 South Bank Road.
The winners of the set top boxes will be notified by 30th April 2009.
