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* 1. Oedran / Age:

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* 2. Rhyw / Sex:

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* 3. Eich tref a chôd post / Your home town and post code:

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* 4. Faint o Gymraeg wyt ti’n siarad / How much Welsh do you speak?

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* 5. A wyt ti’n hyderus yn siarad Cymraeg / Are you confident speaking Welsh?

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* 6. A oes ddigon o Gymraeg o gwmpas Sir Caerffili / Is there enough Welsh around Caerphilly County?

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* 7. A hoffech chi weld fwy o Gymraeg yn cael ei ddefnyddio gan y Cyngor ac gan fusnesau yng Nghaerffili / Would you like to see more Welsh used by the County Council and businesses in Caerphilly?

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* 8. Pa fath o weithgareddau Cymraeg hoffech chi weld yn digwydd yn y Sir / What types of Welsh language activities would you like to see happening in the county?

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* 9. Hoffech chi fynychu fforwm i chi mynegi eich barn? / Would you like to attend a forum to have your say?

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* 10. Eich manylion / Your details
(Enw, ebost, rhif ffon a cod post / Name, email, phone number and post code):

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