Monitoring and Evaluation Questionnaire

QUESTIONS ABOUT YOU

How did you hear about us?

Do you have any comments about the advice service/information which you received from us? Did the advice received help to resolve your problem?

If we referred you to another organisation, do you have any comments about that organisation (please state the name of organisation)?

What is your gender?

Female  Male

What ages are your children?

How old are you?

Are you a lone parent?

Yes  No

Would you consider your family to be on a low income?

Yes  No

Does anyone in your family have a disability?

Please say how you define your ethnicity:

Asian or Asian British - Bangladeshi Asian or Asian British - Indian Asian or Asian British - Pakistani Asian or Asian British - Other Black or Black British - African Black or Black British - Caribbean Black or Black British - Other Chinese Mixed - White and Asian Mixed - White and Black African Mixed - White and Black Caribbean Mixed - Other White - British White - Irish White - Other Other ethnic group - please specify Rather not say

Other ethnicity specified:

Are you a refugee?

Yes  No

Do you live in a rural area?

Yes  No

What is the name of your local council?

QUESTIONS ABOUT YOUR EMPLOYMENT

Are you currently....

Employed Self employed Unemployed Full time carer Voluntary worker Claiming Incapacity Benefit In Further Education or Training On benefits and wishing to return to work

If you work, how many hours a week do you usually work?

If you are employed, how many employees does your employer have?

If you are employed, how long have you worked for your current employer?

If you are employed, are you being threatened with redundancy?

Yes  No

If you are employed what type of job do you have?

Managerial and Administration Professional Associate Professional and Technical Clerical or Secretarial Personal or Protective Sales Plant and Machine Operators Other

If you are employed which sector do you work in?

Agriculture Mining Utilities Food, Drink and Tobacco Textiles and Clothing Chemicals Metals and Mineral Processes Engineering Other Manufacturing Construction Distribution, Hotels etc Transport and Communication Banking and Business Services Professional Services Other Services Health and Education Services Public Administration and Defence Other

ADDITIONAL INFORMATION

Please add any extra information you would like to give here:

CONTACT DETAILS (OPTIONAL)

Can we contact you again to find out how you got on? If so please give contact details. These will be kept confidential and will NOT be passed to third parties.

Please tick here if you only wish to be contacted for the purpose of the prize draw.

Your contact details: