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A new European privacy law called GDPR, or General Data Protection Regulation, came 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?	Yes	No
2. If not, would you like help answering this questionnaire?	Yes	No
3. Have you tried our Website translator?	Yes	No
4. Are you happy to be our consultant?	Yes	No
5. What is your date of birth?
6a. Your first name or initial?
6b. Your Family name ?
7. Please click if you are	Male	Female
8. What year did you start living in Norbiton?
9. How many years do you expect to stay here?
10. Who owns your house?	Local Authority	Right to Buy Freeholder
	Private Rented	Owner Occupier
	Housing Association	Other
	Don’t know or rather not say
11. How many generations live in your household?	1	2	3
12. What is your Employment Status?	Full Time Employed	Part Time Employed
	Self Employed	Retired
	Unemployed	Student/In Training
	Other	Don’t know or rather not say
13. Do you often feel lonely?	Yes	No
If yes, whom can you rely on for support if things go wrong?	My spouse or partner	My Family
	My Friends	My Neighbours
	My Church	Voluntary Agencies
	Social Services	Others
14. Do you often feel worried or under a lot of stress?	Yes	No
If yes, what causes it (Please tick all answers that apply to you)?	Poor health or disability	Fear of attack by strangers
	Family problems e.g. divorce/separation	Refugee from my homeland
	Conflicts with neighbours	Debt
	Change in benefits	Addictions to alcohol etc
	Other
14b. What health problems do you have now (Please tick all that apply to you)	Mobility	Mental Health
	Blood Pressure	Heart
	Ashthma/Bronchitis	Indigestion
	Dental	Blood
	Cancer	Deafness
	Vision	Kidney
	Reproductive	Other
15. If in Debt do you have an expensive high interest Payday Loan?	Yes	No
16. Do you ever have to choose between paying for food or heating your home?	Yes	No
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?	Yes	No
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?	Yes	No
20. Even if you have problems of your own, do you feel you could enjoy life more by becoming a more helpful neighbour?	Yes	No
21. If so, do you think you can offer some informal personal help?	Yes	No
22. Are you caring or helping care for a child under the age of 5?	Yes	No
23. Do you sometimes feel you need help?	Yes	No
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	Helping with our Tuesday Lunches for the Needy and Homeless Joining a Neighbourhood Watch Doing Drop-in Volunteering	Running or attending Post-Code Tea parties Joining Edemocracy

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?	Yes	No
28. What is your ethnic group?
A White	British Irish	Any other White Please tell us
B Mixed	White-Black Caribbean White-Black African	White-Asian Any other mixed Please tell us
C Asian or Asian British	Indian Pakistani	Bangladeshi Tamil
	Korean Any other Asian Please tell us
D Black or Black British	Caribbean African	Any other Black Please tell us
E Chinese or other ethnic group	Chinese	Any other background Please tell us
29. What is your religion or belief?	Christian	Buddhist
	Hindu	Sikh
	Jewish	Muslim
	Atheist	Agnostic
	Other – Please tell us
30. What is your sexual orientation?	Heterosexual (Man and Woman)	Lesbian
	Gay	Bisexual
	Other – Please tell us
Please enter any comments you would like to make about making Norbiton a better place

Translation

Confidential Enquiry

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

Quiz Night

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