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Feedback Form

The following section helps us to identify under or over representation of any protected characteristic, monitor our own diversity and inclusion and measure our impact.

* Indicates required field

Who is completing this form? *

The service recipient/ beneficiary Support worker/ advocate Other

Please specify *

What services have you received from H4C? *

Housing Support (Outreach) Housing Support (Residential) Coaching Training Financial Support Other

If Other is selected please specify *

Stats for monitoring and evidence purposes only. Your name is not connected to this form.

What was your situation? *

Rough sleeping Homeless or temporary accommodation At risk of homelessness Financial hardship At risk of financial hardship Unemployed At risk of unemployment Desiring personal or professional improvement Other

If other is selected please sepecify *

Select any areas that H4C has helped you with *

Budgeting Addiction management Housing management Education Improving relationships/ friendships Self confidence Career confidence Health awareness/ choices Developing hobbies/ activities Preventing anti social or offending behaviour

How helpful has H4C been for your situation? *

Extremely Helpful Very Helpful A Little Helpful Not Helpful

Please add any other comments *

Gender identity *

Female Male Fluid Agender Non-conforming Transgender Prefer not to say Other

Please specify *

Biological gender at birth *

Female Male Prefer not to say

Do you have any physical or mental health conditions or illnesses lasting or expected to last 12 months or more? *

Yes No Prefer not to say

Age category *

18-24 25-34 35-44 45-54 55-64 65+

Do you consider yourself to have a disability or health condition? *

Yes No Prefer not to say

Ethnic origin is not about nationality, place of birth or citizenship. It is about the group to which you perceive you belong.

Ethnicity *

Asian or Asian British Black, African, Caribbean or B/A/C British Mixed or Multiple ethnicity White or White British Prefer not to say Other

If you have selected 'Other' or would like to be more specific please state your perceived ethnicity here *

Sexual orientation *

Heterosexual Gay Lesbian Bisexual Asexual Pansexual Undecided/ Unsure Prefer not to say Other

Please specify *

Religion/ Belief/ World view *

None Buddhist Christian Hindu Jewish Muslim Sikh Atheist/ Secular Humanist Prefer not to say Other

Please specify *

Submit

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