Freedom of Information

Request for information from Glasgow Community and Safety Services

Title *

First name *

Last name *

How would you like to be contacted? Please select

by letterby faxby emailOther

If other, please describe

Your Contact Details

Organisation (if applicable)

House/premises name

House number *

Flat number

Street name *

City/town *

County

Country *

Postcode *

Phone Number

Mobile phone number

Fax number

Email address

Other information about you

(you do not have to provide this information but it will be helpful to us for monitoring purposes)

Ethnic origin

Please Select ... White Scottish White Irish White other British Any other White background Indian Pakistani Bangladeshi Chinese Any other Asian background Black Caribbean Black African Any other Black background Another other ethnic background Not known

Do you consider yourself to be disabled?

No Yes

If so, what is the nature of your disability?

Please indicate which of these groups you represent

If other, please describe

(you do not have to provide this information, but it will be helpful to us for monitoring purposes)