FEEDBACK REPORT

NAME OF YOUR MP REPORT ON PERFORMANCE OF YOUR MP
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 Providing Drinking Water Providing facilities of Sanitation Providing of Doctors / Medical facilities Developing / Maintaining Roads used by you Providing Electric supply Providing Transportation - Buses / Trains Providing you with Security Providing Schools / Colleges in you area Creation of Vocational Training facity Creation of Sports facilities Developing a market place to meet your requirements Providing you with Telephones / Post Offices Providing Bank facilities Keeping inflation under control (Food / Clothing) Are you able to meet him / her as and when required How often does he / she come to your area Does he /she have a criminal background Utilization of their Constituency Development Fund Help in improving your Housing conditions Providing any other Facility
Please Fill Constituency Name Here Please Fill Date Here Put suitable number Put suitable number Put suitable number Put suitable number Put suitable number Put suitable number Put suitable number Put suitable number Put suitable number Put suitable number Put suitable number Put suitable number Put suitable number Put suitable number Put suitable number Put suitable number Put suitable number Put suitable number Put suitable number Put suitable number Please Fill Name Here

Excellent

Very Good

Good

OK

Poor

Very Poor

5

4

3

2

1

0

Public Facilities

Educational Facilities

Commercial Facilities

Availablity Area Development Others Constituency: Date:

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