1.  What is your name? (You do not have to answer this question.)

Name (optional)

2.  What is your email address? (You do not have to answer this question.)

Email (optional)

3.  What is your relationship with the school? (Tick all that apply.)

Parent of child attending school / Governor at school
Parent of child that may attend school in future / Local resident
Parent of child attending another school / Other
Member of staff at school

4.  What is your postcode? (You do not have to answer this question.)

Postcode (optional)

5.  Do you agree with the proposed changes to Hawkedale Infants’ School? (Tick one.)

Agree / Disagree / Don’t know

6.  Do you have any further comments? (You do not have to answer this question.)

7. It would be helpful for us if you would complete the following information, so that we can understand and meet the needs of Surrey’s residents. All data will be held anonymously and in compliance with the Data Protection Act.

7.1 Which of these age groups to you belong to (tick one)?

Up to 14 / 15 to 24 / 25 to 44
45 to 64 / 65 to 84 / 85 or over
I would rather not say

7.2 Do you consider yourself to have a disability or a longstanding condition that affects how you live your life?

Yes / No / I would rather not say

7.3 Are you

Male / Neither male nor female
Female / I would rather not say

7.4 Which one of these groups do you belong to?

Arab
Asian or Asian British Bangladeshi
Asian or Asian British Indian
Asian or Asian British Pakistani
Black or Black British African
Black or Black British Caribbean
Mixed White and Asian
Mixed White and Black African
Mixed White and Black Caribbean
White British
White Irish
White Traveller (including Gypsy, Roma, or Irish Traveller)
Any other White background
Chinese
I would rather not say
Any other background – please specify below

7.5 In which country were you born?

England
Northern Ireland
Scotland
Wales
Republic of Ireland
Other European country (please specify below)
African country (please specify below)
Middle East or Asian country (please specify below)
North American or Caribbean country (please specify below)
Central American country (please specify below)
Antarctica and Oceania (please specify below)

7.6 Are you

Single / Married / Cohabiting
Separated / Divorced / Widowed
In a same sex civil partnership

7.7 Is English your first language?

Yes / No (please specify below)
I would rather not say

7.8 Which of the following faith and belief groups do you identify with?

Buddhist / Sikh
Christian / Hindu
Muslim / None
Jewish / I would rather not say
Other faith or belief (please specify below)

7.9 What is your sexual orientation?

Bisexual / Heterosexual
Gay man / Other
Gay woman/lesbian / I would rather not say

7.10 Does your gender differ from your birth sex?

Yes / No / I would rather not say

7.11 Are you currently pregnant or have you been pregnant in the last year?

Yes / No / I would rather not say

The consultation closes on Friday 3 July 2015. Please either:

·  Leave completed forms at Hawkedale Infants’ School office

·  Send completed forms by post to

Joanna Woodward

Surrey County Council

School Commissioning (Hawkedale Infants’ School Consultation)

Room 326, County Hall, Penrhyn Road

Kingston upon Thames KT1 2DN

·  Email to

·  Complete the online form on Surrey Says https://www.surreysays.co.uk/csf-schools-commissioning team/hawkedale-infants-school/

Thank you.

1

Response to consultation on a proposal to make a significant change to Hawkedale Infants’ School, Sunbury on Thames June 2015 (MS Word version for typed responses)