This survey has been put together to enable us to find out what services that you, the residents of Holbrooks, feel that the community wants and needs to provide better and appropriate support and activities for you. This feedback is extremely important to us, as it ensures that we are providing the services that meet the needs of the community, and enables us to prove need to future funders to provide support and services to the community.

ALL PERSONAL DATA COLLECTED IN THIS FORM WILL NOT BE SHARED WITH ANYBODY, AND WILL BE STORED ONLY ON OUR SECURE SERVER ONLY ACCESSIBLE BY HCCA STAFF.

All completed forms will be entered into a prize draw to win a £100 gift voucher of your choice.

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* 1. Age Range

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* 2. What is your gender identity?

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* 3. What is your ethnicity? (Please select all that apply.)

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* 4. Have you accessed Holbrooks Community Care Association, or Holbrooks Community Centre in the last 12 months?

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* 5. If yes, which services did you access (select all that are relevant)?

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* 6. Which of the following services have you used in the past?

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* 7. Which of the following services would you like to be provided in Holbrooks?

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* 8. Which of the following issues have you experienced in the past 12 months?

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* 9. Have you reported these issues, and if so to whom and were they rectified?

If you would like to be entered into our prize draw to win a £100 gift voucher, please read the below statement and if happy, complete the questions below.

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* 10. DATA PROTECTION!
All information given on this form will be held in the strictest of confidence on a secure server only accessible by HCCA staff in accordance to the Data Protection Act 2018. If you are happy for us to keep this information please tick the box below

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* 11. What is your name?

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* 12. What is your address?

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* 14. Phone number?

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* 15. Date of Birth

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