Confidential Enquiry

 

This form can be automatically translated into many different languages by clicking our translate service on the Home page
A  new European privacy law called GDPR, or General Data Protection Regulation, comes into force on 25 May 2018. The GDPR regulates how organisations may use, store, and delete personal data. In order to remain transparent about how we process your personal data, we are taking this opportunity to reaffirm how your data will be processed and we are inviting you to decide if you wish to continue receiving email correspondence from One Norbiton
Names and email address will be held electronically by One Norbiton unless contacts do not wish us to do so. They can unsubscribe at any time by following the link on our website www.onenorbiton.org.uk

Please help by sharing your ideas with us

We hope to make our ward into one of the friendliest and best places to live, work and study.  So  if you’d like to build up the community feeling here, please fill in this form.

YOUR  POST CODE (E.G. 61 KT1 3JG)

     
     
     
   
1. Can you read and understand English?
2. If not, would you like help answering this questionnaire?
3. Have you tried our Website translator?
4. Are you happy to be our consultant?
5. What is your date of birth?
6a. Your first name or initial?
6b. Your  Family name ?
7. Please click if you are
8. What year did you start living in Norbiton?
9. How many years do you expect to stay here?
10. Who owns your house?
 
 
 
11. How many generations live in your household?
12. What is your Employment Status?
 
 
 
13. Do you often feel lonely?
If yes, whom can you rely on for support if things go wrong?
 
 
 
14. Do you often feel worried or under a lot of stress?
If yes, what causes it (Please tick all answers that apply to you)?
 
 
 
 
14b. What health problems do you have now
(Please tick all that apply to you)
 
 
 
 
 
 
15. If in Debt do you have an expensive high interest Payday Loan?
16. Do you ever have to choose between paying for food or heating your home?
17. We are lucky that a Credit Union called “Boom” operates in Norbiton. This offers borrowing and saving at a fair rate of interest. Would you like to learn more about it?

18. How happy or unhappy, in general, do you feel about living in Norbiton now?              Click the button under the face below to record  how you’re feeling.

0 10 20 30 40 50 60 70 80 90 100
19. Do you fear that delay in getting Universal Credit will stress you?
20. Even if you have problems of your own, do you feel you could enjoy life more by becoming a more helpful neighbour?
21. If so, do you think you can offer some informal personal help?
22. Are you caring or helping care for a child under the age of 5?
23. Do you sometimes feel you need help?
24. Although most people want to volunteer to help their community, they worry about becoming over committed.So we are developing a form of ‘drop in’ volunteering, which will only involve you offering ideas or voting about our projects on line, Please tick which of our current projects interest you


     
25. What is your email address?
26a. What is your phone number?
26b. What is your mobile number?
27. Are you happy for One Norbiton to contact you by email or phone?
28. What is your ethnic group?
A White

B Mixed


C Asian or Asian British

 

D Black or Black British

E Chinese or other ethnic group
29. What is your religion or belief?
 
 
 
 
30. What is your sexual orientation?
 
 
Please enter any comments you would like to make about making Norbiton a better place

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