Name (Optional) Phone (optional) Age (Years)* 0-15 16-20 21-25 26-35 36-45 46-55 56-65 66-75 Gender*

Male Female Prefer not to state What suburb in the Town of Gawler do you reside in?* Gawler Gawler East Gawler West Gawler South Evanston s Evanston Park Willaston Other If other please specify. Do you identify as. Aboriginal Torres Strait What country were you born in?* If you weren't born in Australia, how long have you lived in Australia for? Do you, or someone you know, find language a barrier to living and accessing ser vices within the Town of Gawler? no yes If yes tell us how this could be improved. What are the main services you access within the Town of Gawler? (Examples; heal th, volunteer, child care, employment, sporting, library). Do you feel the services in Gawler meet your needs? (Examples; health, volunteer , child care, employment, sporting, library) . yes no If no then please tell us how this could be better (for example more or better s ervices). Are you the prime carer of another person? (for example a parent, sibling, child (ren), partner, grandparent, friend, relative). No Yes If yes do you have enogh support in your role as a carer? Yes No If no please tell us what support you need? Are there enough programs and events in Gawler for your family to enjoy? (For ex ample community celebrations, festivals, social gatherings or cultural events). Yes No If no please tell us what you would like to attend/see in the community? Are you happy with the community recreation, sporting and leisure facilities and activities in Gawler? (Example; walking trails, parks, arts, meeting places, te am sports, tennis, sporting fields, recreation centres). Yes No If no please tell us what suggestions you have for improvement. Do you feel supported, valued and part of your community? (For example through p articipation in programs, events and services) This question relates to people o f all age groups, cultures and ability. Yes No Please tell us why or why not. Apart from sport, what are the best way to get young people (12-26) involved in the community? (Examples; volunteering, events and services). 75 and above

Evanston Garden

List in order of importance, things that you feel need to be provided or improve d in the Gawler community. What community activities would you participate in, when and if you retire in th e Town of Gawler over the next ten years? (Example; volunteering, social network groups, sports and recreation). Are there any issues within the Gawler community that affect your personal safet y? No Yes If yes then please tell us what they are. What transport do you use to get around the Town of Gawler and to other places? (Example; private, public, dial-a-ride, other). Do you have any problems accessing transport? No Yes If yes then please tell us why/how. Are there any buildings or areas in the Town of Gawler that restrict your access because of their design? (this may relate to having a pram, wheelchairs or phys ical ability). No Yes If yes please tell us why and how this could be improved. Do any of the following topics affect your life? (Please tick). Domestic vilence : Relationship breakdown Financial restaint ol : Gambling Unemployment Health issues Other If other please explain. Drugs : Alcoh

Are you aware of, or have access to services that can help you in these areas? Yes No If no please tell us what support you need. If you needed personal advice or information where would you go? Personal advice (Examples; on moral dilemmas, decision making). Family Friends : Colleagues Services If Services which ones. Information Council : Libary Internet TV : Newspaper If Other please tell us where. Other

How do you prefer to receive information on community services and events? (Emai l, web, local newspaper, junk mail, other) Tell us what is needed. No matter what your age, if you wanted to, would you be able to live independent ly?(This may relate to not having enough money, health issues and availability o f housing or lack of support). Yes No If no please tell us why. Where would you prefer to live if you needed support? In own home In a care facility Other If other please tell us where. Our bush land, parks and bulidings are important to our community, do you have a ny comments? No Yes If Yes then please tell us your ideas.

How would you like the Town of Gawler to be in the year 2020? (Your vision for y our community). Example: Should the Council increase the population, look at sus tainable growth, balance the environment with community and economic issues. Any other comments? Please feel free to attach any other additional information.