Robert's local residents survey
Welcome to local Parliamentary campaigner Robert Alden's local resident survey. Completing the survey will take less than two minutes.
Just before we start we need to know a little about you:- *
Please enter your full name
*
Please enter your postcode
1. Thinking about our local area, are there any issues you would like us to raise with the Council?
2. Which THREE of the following issues are most important for you and your family? *
Required
*
Which THREE of these issues do you think are most important for the Country as a whole?
Required
3. Thinking about the economy for a moment, please say how strongly you agree or disagree with the statement "dealing with Britain's deficit and debt is the only way to get back to a strong economy" on a scale of 0-10, where 0 means disagree strongly and 10 means agree strongly. *
Strongly Disagree
Strongly Agree
4. To help make the survey results representative, how did you vote in the General Election in May 2010? *
Required
5. Have you always voted for that party? (Ie voted for them in 2005 as well as,in 2010) *
Required
6. Looking ahead to the next General Election, as things stand today, what are the chances of you voting for each of the following parties - on a scale of 0-10, where 0 means there would be no chance of you voting for the party and 10 means you would be absolutely certain to vote for the party?
Conservatives
No chance of voting for this party
Certain to vote for this party
Clear selection
Liberal Democrat
No chance of voting for this party
Certain to vote for this party
Clear selection
Labour
No chance of voting for this party
Certain to vote for this party
Clear selection
UKIP
No chance of voting for this party
Certain to covet for this party
Clear selection
BNP
No chance of voting for this party
Certain to vote for this party
Clear selection
Green
No chance of voting for this party
Certain to vote for this party
Clear selection
7. Putting aside party politics and thinking about them as individuals, which of the two main leaders would you prefer as Prime Minister *
Required
8. Again, to help us make the results representative, would you mind telling us...
Your occupation?
If you have kids living at home?
9. Can you help Robert campaign in Erdington and Kingstanding?
10. Finally we would like to keep in touch about local issues and the things you've said concern you most. Can you leave your email address and maybe a phone number? *
Email:-
Mobile number
Home number
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.