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Understanding Your Needs
1. Please supply your date of birth (this helps us identify age related services)
Prefer not to say
2. If you have any disabilities/impairments please tell us what they are. The Disability Discrimination Act 1995 defines a disability as a 'physical or mental impairment which has a substantial and long term adverse effect on your ability to carry out normal day-to-day activities.' Tick all boxes that apply.
Other, please state
3. Please tell us your ethnic group. Tick the box that applies.
If other please specify
4. Please tell us what country you are from and what language you speak. This helps us to identify interpretors and support groups.
5. What is your religion, faith or belief?
6. Please tell us what gender you are.
Other, please specify
7. What is your sexual orientation?
8. Please tell us about any other requirements you have, for example Gypsy, Romany or Traveller; or any other factor you would like included. Please also state if you would prefer someone else to be present if one of our operatives calls to carry out a repair to your property.
9. Please provide your name, address, contact telephone number and your email address.
Do you have access to the inernet
10. How do you prefer us to contact you?
Tick here if you would like to be contacted with information about getting involved with the Council and the decisions that affect you as a tenant.
If you would like further copies of this survey for other members of your household please tick here
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