Brentford Community Survey - for statutory groups

1. About You and Your Organisation

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1. Please enter some details:

Your Name:

Organisation Name:

Address:

Address 2:

Town:

Postal Code:

Your Email Address:

Your Phone Number:

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2. Public contact details, if different from above:

Email Address:

Phone Number:

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3. May we contact you by email, if provided, to get in touch for purposes directly related to the survey? For example, if you have asked for more information.

Yes

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4. If you haven't provided an email address but have given us a telephone number may we use it?

Yes

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5. If you have a website please enter it

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6. Your position within the organisation:

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7. How big is your organisation (number of employees/volunteers)?

just me

under 5

5-49

50+

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8. Are your clients

solely within Brentford

borough wide

regional

national/international

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9. Please provide a brief description of the services you provide

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10. Please give a brief summary of your achievements over the past 3 years (2006-2009)

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11. Please give a brief summary of your current position and where you expect to be in 3 years (2012)

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12. How do you see Brentford (first three adjectives that spring to mind when you think of Brentford)?

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13. Can you cope with the changing demands/needs of the local population?

Yes

No (because)