Department for Children, Adults and Health
Proposal for the development of new Unit for 8 Children with Autistic Spectrum Disorder (ASD) at ChippingSodburySchool
Questionnaire
To help the Council reach a decision about the proposed development of a new unit for eight Children with Autistic Spectrum Disorder (ASD) at ChippingSodburySchool, it would be very helpful if you would answer the following questions.
Completed questionnaires should be returned to:
FREEPOST RRZE-CTRG-TJLJ
South Gloucestershire Council
Chipping Sodbury ASD Consultation
Council Offices
Castle Street
Thornbury
Bristol
BS351HF
To arrive no later than 25 March 2013.
Responses may also be sent by email to:
This document is available on our website at: the questionnaire can be completed on-line.
Please tick the appropriate box
1.How strongly do you agree or disagree that in partnership with ChippingSodburySchool we should develop a new unit for 8 children with Autistic Spectrum Disorder (ASD) at ChippingSodburySchool
Strongly agree
Tend to agree
Neither agree nor disagree
Strongly disagree
Don’t know
1a. Please use this space to make any comments about the proposal
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2. Without prejudice to your answer to question 1, if the decision is taken to development of new Unit for 8 Children with Autistic Spectrum Disorder (ASD) at ChippingSodburySchool do you agree that the changes should take place from January 2014, if at all possible?
Strongly agree
Tend to agree
Neither agree nor disagree
Strongly disagree
Don’t know
2a. Please use this space to make any comments about the proposal
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3. Please state any additional points or views, which you would like to be taken into account?
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(Please attach additional sheets if necessary).
4. Please indicate below (tick box) which of any of the following apply to you.
I am a:
- parent of a pupil currently attending ChippingSodburySchool;
- pupil currently attending ChippingSodburySchool;
- parent of child/children who have a diagnosis of ASD
- child/young person who have diagnosis of ASD
- governor of ChippingSodburySchool;
- teacher of ChippingSodburySchool;
- member of non-teaching staff of ChippingSodburySchool;
- other interested party (please state below)
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By answering the following questions, if you wish, you will help us to monitor the council’s services for quality and fairness. Any answers you give will be treated as confidential. Please tick the relevant box.
Q5. How Old Are You?
18 and under
19 – 24
25 – 44
46 – 64
65 – 74
75 and over
Prefer not to say
Q6. Are You?
Female
Male
Prefer not to say
Q7. Do you consider yourself to be disabled?
Yes
No
Prefer not to say
If yes, please tell us what impact this has on how you access local services.
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Q8. What is Your Ethnic Origin?
Arab
Asian/Asian British – Bangladeshi
Asian/Asian British – Indian
Asian/Asian British – Pakistani
Asian/Asian British – Chinese
Asian/Asian British – Other (please state below)
Black/African/Caribbean/Black British – African
Black/African/Caribbean/Black British – Caribbean
Black/African/Caribbean/Black British – Other (please state below)
Gypsy or Traveller of Irish Heritage
Mixed/Multiple Ethnic Groups – White & Asian
Mixed/Multiple Ethnic Groups – White & Black African
Mixed/Multiple Ethnic Groups – White & Black Caribbean
Mixed/Multiple Ethnic Groups – Other (please state below)
White – English/Welsh/Scottish/Northern Irish/British
White – Irish
White – Other (please state below)
Other ethnic group (please state below)
Prefer not to say
Please state if selected ‘other’ to any of the above.
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Thank you for taking the time to complete this questionnaire. Written comments are welcome in any form in addition to the return of this questionnaire (please attach additional sheets securely).
Please send all completed questionnaires and additional comments by
25th March 2013.