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1. In 2012, the Big Lottery is giving 1,000,000 to the Worm holt & Wh ite City Area, to

be spent ove r 10 years. From 2012, all residents in the Area will have an opportunity

to decide how this money is to be spent.

If it was up to you, what would you spend the money on?

2. Which W ormholt & W hite City Big Local Area do you live In?

3. How did you find out about Wormholt & White City Big Local?

4. What activities w ould you suggest to promote W ormholt & W hite City Big Local?

5. What nam e should we give to the W ormholt & W hite City Big Local?

About the Wormholt & White City Big Local

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Batman Closenmlkj

Cleverly Estate

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White City Closenmlkj

White City Estate

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Wormholt Estatenmlkj

Other (please specify)

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Active Planet - Engaging Users

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Afghan Council UK - Engaging Users

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Albert & Friends Instant Circus - Open House

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Community Transformation Partnership

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HAFAD - Engaging Users

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Keeping Youth Active (KYA) - Engaging Users

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Opportunities for All - Big Local = Community

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Opportunities for All - Engaging Carers

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QPR in the Community - Engaging Older People

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Somali Women Support and Development Group - Mother

& Daughter Open Mic

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Women's Radio Group/London Link Radio - Inside Out

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Website

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Other (please specify)

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These Questions Are Optional. The information you provide will be held in confidence and will be used anonymously.

It will not be shared with any other agency.

8. Wh at is your e thnicity?

11. Please prov ide the following information if you would like to be kept inform ed. (This information w ill be used for mailing information about W &W C B ig Local only

and w ill not be shared w ith anyone else)

Please tell us About Yourself

6. Are you

7. Age

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9. Are YouYes No

Disabled nmlkj nmlkj

A Parent nmlkj nmlkj

A Carer nmlkj nmlkj

Employed nmlkj nmlkj

Unemployed nmlkj nmlkj

A Student nmlkj nmlkj

10. If you would like to be kept informed about W ormholt &

W hite City Big Local, please tell us how:Yes No

Text nmlkj nmlkj

Email nmlkj nmlkj

Mail nmlkj nmlkj

Our Website nmlkj nmlkj

Name

Address

Email

Landline / Mobile

Male

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nmlkj 51-65

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