Housing Standards response publishing survey - Page 1 of 4 - Example Site

Introduction

1. What is your name?

Name

2. What is your email address?

This is optional, but if you enter your email address then you will be able to return to edit your consultation at any time until you submit it. You will also receive an acknowledgement email when you complete the consultation.

3. What is your organisation?

Organisation

4. What area do you live in?

Central Arlen East Arlen West Arlen North Arlen South Arlen Outside of Arlen Hill

5. Do you consent for your response to be published?

Yes Yes, but without idenifying information No