First name
Last name
Email
Mobile
1.
Select your age bracket
Please select
14-18
18-24
25-34
35-44
45-54
55-64
65+
2.
How do you describe your gender?
Please select
Woman
Man
Non-binary
Prefer not to say
Other
3.
What is your occupation?
4.
What do you value about living here? What do you think makes our community unique?
5.
What do you think is the biggest problem with politics?
6.
What do you think are the qualities of a really good political representative?
7.
On a scale of 1-5 (with 5 being the best, and 1 the worst) our current political representation/representative here in X?
8.
From the list below select the top 5 issues that are most important to you.
Please select
Improving public transport
Strengthening the economy
More action on climate change
Tackling housing affordability (including renters)
Reducing the cost of living
Tackling socioeconomic equality
Justice and support for First Nations People and reconciliation
Integrity in politics
Better funding for our schools Universities
Health Care/Medicare
Protecting the Environment
Fixing our aged care system
More support for those living with disability
Improving Superannuation, retirement, aged pension
Fair treatment for refugees and people seeking asylum
Access to quality and affordable childcare/
Reducing unemployment
Workers rights and conditions
Lowering income tax rates
Better support for local businesses
Justice and support LGBTIQ+ people and other marginalised groups
9.
Is there another issue that is important to you that was not in the list above?
10.
Is there a local issue that you think is not getting enough political attention?
11.
What do you think the biggest issues facing our community will be in the next 5 years?
12.
Where did you come across this survey?
13.
Would you like to volunteer with the local community independent group? Yes/No
Please select
Yes
No