Student handout 3: Community issues survey

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Our class has identified the following concerns as key issues of importance.
We would like to know about the issues important to other members of our community.

Please complete the survey form and return it to _______________________ by _______

Issue	Are you aware of this issue? Yes/No	Do you consider this issue important? Yes/No	What should be done about this issue?
Local issues
State issues
National issues

Please add any other issues that are important to you. Name the key groups involved and what you think should be done about this issue.

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

Are you a member of any interest group (for example local residents group, trade union, employer organisation, environment group and health or welfare group?

Name (optional) ______________________________________________________

Age (please circle): Under 18    18-30    30-50    Over 50

________________________________________________________________________

Thank you for participating in our survey.

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