Have your say on the Future Shoreditch Area Action Plan

1. Name:

(Required)

2. Email address:

(Required)

3. Address:

(Required)

4. Postcode:

(Required)

5. Are you taking part in this consultation as an individual or representing an organisation?

(Required) Individual / member of the public Voluntary or community sector organisation Local authority Councillor Agent of another organisation Other

If other, please specify:

About You Section

The questions below are optional and will not be used in a way that identifies you.

This information will help us to understand our service users and residents, allowing us to establish if the response to the questionnaire is representative of the borough. All information is used under the strict controls of the 1998 Data Protection Act and the 2016 General Data Protection Regulations (GDPR).

6. Gender: Are you...

Male Female Non Binary Another term Prefer not to say

If you prefer to use your own term please provide this here:

7. Age: what is your age group?

Under 16 16-17 18-24 25-34 35-44 45-54 55-64 65-74 75-84 85+

8. Disability: Under the Equality Act you are disabled if you have a physical or mental impairment that has a 'substantial' and 'long-term' negative effect on your ability to do normal daily activities. Do you consider yourself to be disabled?

Yes No

9. Caring responsibilities: A carer is someone who spends a significant proportion of their time providing unpaid support to a family member, partner or friend who is ill, frail, disabled or has mental health or substance misuse problems. Do you regularly provide unpaid support caring for someone?

Yes No

10. Ethnicity: Are you...

White- English, Welsh, Scottish, Northern Irish or British White- Irish White- Gypsy or Irish Traveller White- Roma White- European Mixed White- Kurdish White- Turkish White-Turkish Cypriot White- Eastern European White- Western European White Jewish Charedi Jewish Black British Black- Caribbean Black- African Asian - Indian Asian- Pakistani Asian- Chinese Asian- Bangladeshi Asian- Sri Lankan Asian- Vietnamese Asian Mixed- White & Black Caribbean Mixed-White & Black African Mixed- White & Asian Mixed- Other Arab South American Other Prefer not to say

Other (please state if you wish):

11. Religion or belief: Are you or do you have...

Atheist/no religious belief Christian Muslim Buddhist Hindu Secular beliefs Charedi Jewish Sikh

Other (please state if you wish):

12. Sexual orientation: Are you...

Heterosexual Bisexual Gay man Lesbian or Gay woman Pansexual Asexual Queer All other sexual orientations Prefer not to say

Other (please state if you wish):

13. Housing Tenure: Which of the following best describes the ownership of your home?

Being bought on a mortgage Owned outright Rented (Local Authority/Council) Rented (Housing Association/Trust) Rented (private) Shared ownership (part rent/part buy) Don’t know

Have your say on the Future Shoreditch Area Action Plan

Part A - Personal details

About You Section

The questions below are optional and will not be used in a way that identifies you.