* 1. Name

* 2. Address

* 3. Date of Birth

Date:
/
/

* 4. Gender

* 5. Please provide your tenancy start date:

Date:
/
/

* 6. How many bedrooms does your home have?

* 7. Landline Phone Number

* 8. Mobile Number

* 9. Email Address

* 10. Household Income Per Year

Under £10k
i We adjusted the number you entered based on the slider’s scale.

* 11. Are You Currently Employed:

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

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

* 14. What is your preferred language?

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

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

* 17. Details of household member two:

* 18. Details of household member three:

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

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

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

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

* 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?

* 24. What would make our website more useful?

* 25. Have you heard about our texting service?

* 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.

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

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