TEST webpage Community Safety CCTV and Technology Initiatives Submission Form

Let's start by getting to know you.

We know our community is diverse, and we want to make sure everyone’s voice is heard.
These questions help us understand who we’re hearing from, so we can ensure our engagement
represents the whole City of Melville community. Not all questions are mandatory, but we encourage you to answer them. Your responses will remain confidential.

Question Title

* 1. Name

Question Title

* 2. What is the suburb where you live?

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* 3. How are you connected to the City of Melville?
👉 Select all that apply.

I own or am paying off a home in the City of Melville (ratepayer)

I rent a home in the City of Melville

I own property or pay rates in the City of Melville but live elsewhere

I work or provide services in the City of Melville

I own or operate a business in the City of Melville

I study in the City of Melville

I visit the City of Melville regularly (for shopping, recreation, or services)

I recreate or take part in community activities in the City of Melville (e.g. sport, clubs, arts)

I am a developer or represent a development company

Connection not listed above (please specify):

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* 4. Which is your age group?

Under 9

10-19

20-29

30-39

40-49

50-59

60-69

70-79

80+

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* 5. Do you identify as a:

Man or male

Woman or female

Non-binary

I use a different term

Prefer not to answer

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* 6. Which of the following applies to you, or to the organisation or person you represent?
👉 Select all that apply.

Aboriginal or Torres Strait Islander

From a culturally and linguistically diverse, migrant or refugee background

Living with disability, neurodivergence, or lived experience of mental health challenges

Identifies LGBTQIA+ community

TEST webpage Community Safety CCTV and Technology Initiatives Submission Form

Question Title

* 1. Name

Question Title

* 2. What is the suburb where you live?

Question Title

* 3. How are you connected to the City of Melville? 👉 Select all that apply.

Question Title

* 4. Which is your age group?

Question Title

* 5. Do you identify as a:

Question Title

* 6. Which of the following applies to you, or to the organisation or person you represent?👉 Select all that apply.

Question Title

* 7. Email address👉Include if you wish to be informed of the outcomes of this engagement.

* 3. How are you connected to the City of Melville?
👉 Select all that apply.

* 6. Which of the following applies to you, or to the organisation or person you represent?
👉 Select all that apply.

* 7. Email address
👉Include if you wish to be informed of the outcomes of this engagement.