Name

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* 1. Name

Address

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* 2. Address

Date of Birth

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* 3. Date of Birth

Date:
Gender

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* 4. Gender

Please provide your tenancy start date:

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* 5. Please provide your tenancy start date:

Date:
How many bedrooms does your home have?

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* 6. How many bedrooms does your home have?

Landline Phone Number

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* 7. Landline Phone Number

Mobile Number

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* 8. Mobile Number

Email Address

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* 9. Email Address

Household Income Per Year

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* 10. Household Income Per Year

Under £10k £50k +
i We adjusted the number you entered based on the slider’s scale.
Are You Currently Employed:

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* 11. Are You Currently Employed:

What benefits do you receive, if any?

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* 12. What benefits do you receive, if any?

Verification document provided (please email to customer.services@coophomes.coop):

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* 13. Verification document provided (please email to customer.services@coophomes.coop):

What is your preferred language?

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* 14. What is your preferred language?

What is the ethnic origin of the lead tenant?

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* 15. What is the ethnic origin of the lead tenant?

Please provide details of other members of the household. Household member one:

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* 16. Please provide details of other members of the household. Household member one:

Details of household member two:

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* 17. Details of household member two:

Details of household member three:

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* 18. Details of household member three:

Please provide details of any other household members:

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* 19. Please provide details of any other household members:

Do you or any member of your family have a disability? (please specify below)

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* 20. Do you or any member of your family have a disability? (please specify below)

Do you have easy and regular access to the internet?

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* 21. Do you have easy and regular access to the internet?

If no, would you like help to get online?

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* 22. If no, would you like help to get online?

Are you signed up to MyTenancy, your online account with Co-op Homes which enables you to manage your tenancy and book repairs online?

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* 23. Are you signed up to MyTenancy, your online account with Co-op Homes which enables you to manage your tenancy and book repairs online?

What would make our website more useful?

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* 24. What would make our website more useful?

Have you heard about our texting service?

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* 25. Have you heard about our texting service?

If you have used the texting service, what did you like/dislike?

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* 26. If you have used the texting service, what did you like/dislike?

Thank you for taking part in this survey! Once you click 'done', you will be entered into our prize draw to win £50 in Love2Shop vouchers.
Please note, this survey is strictly confidential and Co-op Homes will not share the details you provide with any third party.
Is there anything you feel that Co-op Homes could do to improve our service to you?

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* 27. Is there anything you feel that Co-op Homes could do to improve our service to you?

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