Screen Reader Mode Icon
The purpose of this form is to gather information to better understand the needs of our tenant base and support how we deliver services now and in the future. The form is completely anonymous and your support in completion would be greatly appreciated.
Responses will remain anonymous

Question Title

* 1. Please tick the band for your age:

Question Title

* 2. Please tick the box which best describes your belief or religion from the list below?

Question Title

* 3. Please tick the box that best describes your particular group.

Question Title

* 4. Are you presently in a civil partnership?

Question Title

* 5. Are you presently married?

Question Title

* 6. Are you pregnant?

Question Title

* 7. Have you taken maternity or paternity leave in the past year?

Question Title

* 8. What is your sex?

Question Title

* 9. Do you consider yourself to be a trans person?

Question Title

* 10. What is your sexual orientation?

Question Title

* 11. Does anyone living in this household have any long term illness, health problem or disability which limits their daily activities or the work they can do (including problems due to old age)?

Question Title

* 12. What is the nature of their disabilities?

Question Title

* 13. Which of the following best describes the main source of your household income? [SELECT ONE ONLY]

Question Title

* 14. Do you or anyone in your household currently receive any help or support with any of the following issues that would help you/ your household continue to live in your house independently? Select all that apply:

Question Title

* 15. Do you/ anyone in your household need any help or support, that you do not currently receive, with any of the following issues that would help you/ your household continue to live in your house independently? Select all that apply:

Question Title

* 16. If you receive support, who is this provided by? Select all that apply:

0 of 16 answered
 

T