| Your Age |
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| Your Gender |
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| On which street to you reside? Please provide nearest cross streets. |
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| Over the past 2 years, do you believe the quality of life in your neighborhood has: |
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| What do you feel the greatest problem is in your neighborhood? |
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| Are you fearful of becoming the victim of a crime? |
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| Have you ever interacted with Manchester Police Officers? |
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| How would you rate the helpfulness of Manchester Police Officers? |
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| How would you rate the courtesy of Manchester Police Officers? |
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| Do you feel the Manchester Police Department provides a safe and secure community for you to live? |
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| How would you rate the Manchester Police Department as a whole? |
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| What, if anything, would you like to change about the Manchester Police Department? |
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| Please rate the quality of service that the Manchester Police Department provides to the community: |
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| First Name - Optional |
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| Last Name - Optional |
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| City - Optional |
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| State - Optional |
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| Zip - Optional |
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| Telephone - Optional |
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| Email - Optional |
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