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Feedback Details

Title:

*First Name:  

*Surname:  

Organisation:

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Town / City:

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Telephone:

*Email Address:    

*Feedback Type: Complaint Freedom of Information Comment/Suggestion Compliment Enquiry - From a Parish Enquiry - To the Leader Enquiry - From a Member Enquiry - From an MP Enquiry - From a Customer  

*Summary:  

Desired Outcome:

To help us meet our duties under equality legislation and in line with the Council's policy on equality and diversity, please provide us with the following details.

You do not have to complete this section if you don't want to, but it may help us to monitor and improve our services if you do. Please answer any questions you feel comfortable with.

The information you have supplied will be kept confidential.

Personal Details

Gender: Female Male Multiple Not Disclosed Other

Age Group: .Under 5 05 - 10 11 - 15 16 - 19 20 - 24 25 - 59 60 - 64 65 + 65 -75 76+ Not Disclosed

Ethnic Group: Asian or Asian British - Any other Asian Background Asian or Asian British - Bangladeshi Asian or Asian British - Indian Asian or Asian British - Pakistani Black or Black British - African Black or Black British - Any other Black Background Black or Black British - Caribbean Chinese or Other Ethnic Group - Any other Ethnic Background Chinese or Other Ethnic Group - Chinese Chinese or Other Ethnic Group - Gypsy Mixed - Any other Mixed background Mixed - White and Asian Mixed - White and Black African Mixed - White and Black Caribbean White - Any Other White - White background White - White British White - White Irish

Faith / Belief: Christian Hindu Jewish Muslim None Not Disclosed Sikh

Disability: No Not Disclosed Yes