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Your Views
How did you find the process of accessing the funding?
*
Very easy
Somewhat easy
Not sure
Somewhat difficult
Very difficult
Is there anything about the process or experience of accessing the funding that could be improved?
What did you use the fund for? Please select all that apply
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Home security (e.g. video doorbell)
Urgent essentials (e.g. food, clothing)
Travel to safe accommodation (e.g. taxi/train to refuge)
Moving costs (e.g. removal van when moving to safe accommodation)
Other (please secify)
Date/Time of Submission
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Day
-
Month
Year
Date
Hour Minutes
To what extent do you agree or disagree that the funding has:
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Strongly agree
Agree
Not sure
Disagree
Strongly disagree
N/A
Provided you with items to improve your safety at home
Increased feelings of safety for you
Increased feelings of safety for your children
Assisted you in moving to a new location of safety
Had a positive impact on your mental health and wellbeing
Had a positive impact on your physical health
Helped you to manage financial difficulties
Helped you to access education and learning opportunities
Helped you to access employment opportunities
Please briefly describe the difference that this funding has made to your life, if any?
How might things be different for you if you had not received support from this funding?
Is there anything else you would like to tell us about your experience of accessing the funding?
About you
Which district, city or borough do you live in?
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Basildon
Braintree
Brentwood
Castle Point
Chelmsford
Colchester
Epping
Harlow
Maldon
Rochford
Tendring
Uttlesford
Southend
Thurrock
Prefer not to say
What is your gender?
*
Please Select
Female
Male
Inter-sex
Gender Queer
Non Binary
Other
Don’t Know
Declined
Which age group do you belong to?
*
18-24
25-34
35-44
45-54
55-64
65+
Prefer not to say
Which one of the following best describes your ethnic group or background?
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Asian or Asian British - Bangladeshi
Asian or Asian British - Chinese
Asian or Asian British - Indian
Asian or Asian British - Other
Asian or Asian British - Pakistani
Black or Black British - African
Black or Black British - Caribbean
Black or Black British - Other
Mixed - Other
Mixed - White and Asian
Mixed - White and Black African
Mixed - White and Black Caribbean
Other
Other - Arab
White - British
White - Gypsy / Irish Traveller
White - Irish
White - Other
Prefer not to say
Do you consider yourself to have a health condition, disability or impairment? Please tick all that apply.
No impairment
Hearing impairment/deaf
Visual impairment/blind
Deafblind
Mental health needs
Drug or alcohol addiction
Physical impairment
Learning difficulties/disabilities
Autism spectrum disorder
Prefer not to say
Other (please specify)
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