The Neighbourhood Action Group wants to know what concerns you the most about your local area so we can work together to deal with these issues. To help us do this, please tell us what you consider to be the three most important issues in your neighbourhood. Please tell us when and where any problems occur and indicate whether you consider them to be minor, moderate or serious.

Please state the estate or street where you live:



1:


Minor
Moderate
Serious

2:


Minor
Moderate
Serious

3:


Minor
Moderate
Serious

Postcode:


Gender:


Male
Female

Your Faith:


Other comments or information:


Your Age:


10 to 16
18 to 19
20 to 24
25 to 29
30 to 44
45 to 59
60 to 64
65 to 74
75 to 84
85 to 90
90+

Ethnic group / nationality:



White
British
Irish
Any other White Background
Asian or Asian British
Indian
Pakistani
Bangladeshi
Any other Asian Background
Black or Black British
Black Caribbean
Black African
Any other Black Background
Chinese
Chinese
Dual Heritage
White & Black Caribbean
White & Black African
White & Asian
Any other mixed background
Other ethnic group
Other
Nationality (if different):

If you would like us to get in touch about any issue, please tell us how we can contact you: