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MVA Resource Guide Questionnaire

For help in completing the questionnaire, you can check the guidance notes on Help with Questionnaire.

To download the Word 2000 version of the questionnaire for postal or fax transfer, right click your mouse button and select "Save Target As..." and save the document to your computer.

Questionnaire to Guide

Section A: Main contact details

Full name of Organisation:
Acronym:
Street:
Town:
Post Code:
Telephone:
Fax:
Mini-com:
* E-mail: (Must provide)
Website:
Opening Times:
Monday:
Tuesday:
Wednesday:
Thursday:
Friday:
Weekend:
Any comments to add about the opening times?
If possible, please nominate an individual for contact/correspondent purposes.
Name of contact person:
Role in organisation:
Does your organisation have a logo? If yes, you can email a copy of it to william.liu@mvacvs.org.uk, make sure you include in the email who you are.

Section B: Your organisation and its services

(i)
A summary/statement of aims and objectives, functions and services of organisation (no more than 100 words):

(ii)

What category(ies) does your organisation go under?

In the grey column (indicated by a *) below, please check ONE box that best describes the MAIN work of your organisation. This is the area of the Resource Guide where your entry will appear. If you wish to cross reference your organisation in other fields, please indicate in the right hand side column, up to no more than four other categories and we will include a reference under these categories directing people to your main entry.

*     *    
Accommodation Equality & Anti-Discrimination
Addictions Health
Advice/Support/Counselling Information Services
Advocacy Learning Difficulties
Arts & Recreation/Leisure Legislation
Carers Mental Health
Children & Young People Older People
Crime Prevention/Law & Order/Victim Support Transport
Disabilities & Limiting Illness Unemployment/Low income
Education & Training Voluntary/Voluntary sector support
Environment
Others (Please state):
 

(iii)
Are you a voluntary or statutory organisation?
Statutory
Voluntary
If Voluntary, what is the status of your organisation? (Please tick where appropriate)
Charity recognised by Inland Revenue Company Limited by Guarantee
Has a constitution Has a Voluntary Management Committee
Trust Informal Group
Other (Please state):

(iv)

Client Target:

We appreciate that your organisation may be involved in many fields and areas, if your answer to the question below exceeds 5, please do NOT give more than 5 answers at this time, the more you select, the less helpful the Resource Guide becomes.

Who is your main client target group?
Individuals Organisations Environment General Public
Who would benefit from your services?
A community within a geographic area People in debt
Armed/ex services People on low income/affected by poverty
Bereaved People with learning disabilities
Business & Enterprise People with mental health problems
Carers People with physical disabilities
Children People with sensory disabilities
Ethnic Minorities Refugees/asylum seekers
Families Rural areas
Gay/Lesbian/Bisexual Substance users
Homeless/in housing difficulty Travellers
Individuals suffering limiting illnesses Unemployed
Men Victims of abuse
Offenders/ex-offenders Victims of crime
Older People

Volunteers

Parents Women
People affected HIV/AIDS Youth/Young People
Others (Please specify):

(v)

What facilities/services does your organisation provide?

If your answer to the question below exceeds 5, please do NOT give more than 5 answers at this time, if you select too many choices, it makes the guide become less helpful.

The choices you select here would be used in a cross-reference section at the start of the Resource Guide, where the user could look up the type of service they need, and seek out details of your organisation in that particular section.

Accommodation/Housing Life Long Learning
Advice & Information Lobbying
Arts/Culture Mediation/Arbitration
Awareness Raising Mental Health
Befriending/Buddying Networking
Campaigning Office/computer services/support
Childcare Parenting
Community Business Publicity
Conservation/Environment Management Relationship Counselling
Counselling Residential care
Day Care Centre Respite care
Debt Counselling Self help
Development Social/recreation activities
Domiciliary Care Social Security/Benefits
Drop-in Sport/Leisure
Entertaining/Performing Support Groups
Financial Services Trading company
Fundraising Training facilities
Health promotion Transport services
Independent advocacy/representation Volunteering
Information Resource/Library Welfare rights
Legal Services  
Others (Please specify):


Section C: Organisation operation

Do people have to pay to use your organisation? Yes No
Comments/Details:

Who can refer peple to yor organisation?
Community Nurses Others (Please specify):
General Practitioners
Housing Officers
Social Workers
Themselves (Self-referral)
Voluntary organisations
Anyone

How should people get in touch with your organisation?
(Include the Referral Path if appropriate)

Any other commens to add?

You are most welcome to submit any leaflets or brochures to support the questionnaire if you feel it necessary. You could email electronic versions to william.liu@mvacvs.org.uk, or post them directly to the MVA office.

Midlothian Voluntary Action
4/6 White Hart Street
Dalkeith
Midlothian
EH22 1AE


Section D: Your Consent

The details you have submitted will be processed and reproduced as a Resource Guide that serves the Midlothian area, in paper copy, CD and web format.

Please tick where appropriate

I give consent to Midlothian Voluntary Action using the information submitted to provide for:

Yes No  
The MVA Resource Guide
Enquiries over the phone
Enquiries in writing
Information being made available on the Internet
Comments:
Form filled in by[1]: (Must provide)
Role in organisation: (Must provide)
Dated:
[1] Please ensure that the person who signs this has authority to give the consent for this questionnaire.

If you know another group or any other individual that would be of help to the resource, please direct them to us.

Thank you for your time!

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