INQUILAB Residents Needs Assessment Survey

You and your Household

This is a household survey which aims to find out about the makeup and needs of all INQUILAB residents living in each of our households. Some of the questions in the survey will ask about you and some about your whole household. Please tell us about yourself and then about everyone living in your home, from the oldest to the youngest. Please answer every question completely.

Question Title

* 1. Your name, address and contact details

Name

Address

Address 2

Borough/Town

Postal Code

Email Address

Phone Number/Mobile Number

Question Title

* 2. How many people live in your household?

1 Person

2 People

3 People

4 People

5 People

6 People

7 People

8 People

Question Title

* 3. What is the gender make up of residents in your household? Please start with yourself and then record for the oldest person to the youngest, making sure that you have answered for each member of your household.

	Person 1	Person 2	Person 3	Person 4	Person 5	Person 6	Person 7	Person 8
Male	Male Person 1	Male Person 2	Male Person 3	Male Person 4	Male Person 5	Male Person 6	Male Person 7	Male Person 8
Female	Female Person 1	Female Person 2	Female Person 3	Female Person 4	Female Person 5	Female Person 6	Female Person 7	Female Person 8
Trans	Trans Person 1	Trans Person 2	Trans Person 3	Trans Person 4	Trans Person 5	Trans Person 6	Trans Person 7	Trans Person 8
Prefer not to say	Prefer not to say Person 1	Prefer not to say Person 2	Prefer not to say Person 3	Prefer not to say Person 4	Prefer not to say Person 5	Prefer not to say Person 6	Prefer not to say Person 7	Prefer not to say Person 8

Question Title

* 4. What is your age and the ages of everyone in your household? Please start with yourself and then record for the oldest person to the youngest, making sure that you have answered for each member of your household.

	Person 1	Person 2	Person 3	Person 4	Person 5	Person 6	Person 7	Person 8
Under 5	Under 5 Person 1	Under 5 Person 2	Under 5 Person 3	Under 5 Person 4	Under 5 Person 5	Under 5 Person 6	Under 5 Person 7	Under 5 Person 8
5-11	5-11 Person 1	5-11 Person 2	5-11 Person 3	5-11 Person 4	5-11 Person 5	5-11 Person 6	5-11 Person 7	5-11 Person 8
12-16	12-16 Person 1	12-16 Person 2	12-16 Person 3	12-16 Person 4	12-16 Person 5	12-16 Person 6	12-16 Person 7	12-16 Person 8
17-20	17-20 Person 1	17-20 Person 2	17-20 Person 3	17-20 Person 4	17-20 Person 5	17-20 Person 6	17-20 Person 7	17-20 Person 8
21-24	21-24 Person 1	21-24 Person 2	21-24 Person 3	21-24 Person 4	21-24 Person 5	21-24 Person 6	21-24 Person 7	21-24 Person 8
25-34	25-34 Person 1	25-34 Person 2	25-34 Person 3	25-34 Person 4	25-34 Person 5	25-34 Person 6	25-34 Person 7	25-34 Person 8
35-44	35-44 Person 1	35-44 Person 2	35-44 Person 3	35-44 Person 4	35-44 Person 5	35-44 Person 6	35-44 Person 7	35-44 Person 8
45-54	45-54 Person 1	45-54 Person 2	45-54 Person 3	45-54 Person 4	45-54 Person 5	45-54 Person 6	45-54 Person 7	45-54 Person 8
55-64	55-64 Person 1	55-64 Person 2	55-64 Person 3	55-64 Person 4	55-64 Person 5	55-64 Person 6	55-64 Person 7	55-64 Person 8
65-74	65-74 Person 1	65-74 Person 2	65-74 Person 3	65-74 Person 4	65-74 Person 5	65-74 Person 6	65-74 Person 7	65-74 Person 8
75+	75+ Person 1	75+ Person 2	75+ Person 3	75+ Person 4	75+ Person 5	75+ Person 6	75+ Person 7	75+ Person 8

Other (please specify)

Question Title

* 5. What is your ethnic origin and the ethnic origin of everyone else living in your home? Please start with yourself and then record for the oldest person to the youngest, making sure that you have answered for each member of your household.

	Person 1	Person 2	Person 3	Person 4	Person 5	Person 6	Person 7	Person 8
White: English/Welsh/Scottish/Northern Irish/British	White: English/Welsh/Scottish/Northern Irish/British Person 1	White: English/Welsh/Scottish/Northern Irish/British Person 2	White: English/Welsh/Scottish/Northern Irish/British Person 3	White: English/Welsh/Scottish/Northern Irish/British Person 4	White: English/Welsh/Scottish/Northern Irish/British Person 5	White: English/Welsh/Scottish/Northern Irish/British Person 6	White: English/Welsh/Scottish/Northern Irish/British Person 7	White: English/Welsh/Scottish/Northern Irish/British Person 8
White: Irish	White: Irish Person 1	White: Irish Person 2	White: Irish Person 3	White: Irish Person 4	White: Irish Person 5	White: Irish Person 6	White: Irish Person 7	White: Irish Person 8
White: Gypsy or Irish Traveller	White: Gypsy or Irish Traveller Person 1	White: Gypsy or Irish Traveller Person 2	White: Gypsy or Irish Traveller Person 3	White: Gypsy or Irish Traveller Person 4	White: Gypsy or Irish Traveller Person 5	White: Gypsy or Irish Traveller Person 6	White: Gypsy or Irish Traveller Person 7	White: Gypsy or Irish Traveller Person 8
White: Other White	White: Other White Person 1	White: Other White Person 2	White: Other White Person 3	White: Other White Person 4	White: Other White Person 5	White: Other White Person 6	White: Other White Person 7	White: Other White Person 8
Asian/Asian British: Indian	Asian/Asian British: Indian Person 1	Asian/Asian British: Indian Person 2	Asian/Asian British: Indian Person 3	Asian/Asian British: Indian Person 4	Asian/Asian British: Indian Person 5	Asian/Asian British: Indian Person 6	Asian/Asian British: Indian Person 7	Asian/Asian British: Indian Person 8
Asian/Asian British: Pakistani	Asian/Asian British: Pakistani Person 1	Asian/Asian British: Pakistani Person 2	Asian/Asian British: Pakistani Person 3	Asian/Asian British: Pakistani Person 4	Asian/Asian British: Pakistani Person 5	Asian/Asian British: Pakistani Person 6	Asian/Asian British: Pakistani Person 7	Asian/Asian British: Pakistani Person 8
Asian/Asian British: Bangladeshi	Asian/Asian British: Bangladeshi Person 1	Asian/Asian British: Bangladeshi Person 2	Asian/Asian British: Bangladeshi Person 3	Asian/Asian British: Bangladeshi Person 4	Asian/Asian British: Bangladeshi Person 5	Asian/Asian British: Bangladeshi Person 6	Asian/Asian British: Bangladeshi Person 7	Asian/Asian British: Bangladeshi Person 8
Asian/Asian British: Chinese	Asian/Asian British: Chinese Person 1	Asian/Asian British: Chinese Person 2	Asian/Asian British: Chinese Person 3	Asian/Asian British: Chinese Person 4	Asian/Asian British: Chinese Person 5	Asian/Asian British: Chinese Person 6	Asian/Asian British: Chinese Person 7	Asian/Asian British: Chinese Person 8
Asian/Asian British: Other Asian	Asian/Asian British: Other Asian Person 1	Asian/Asian British: Other Asian Person 2	Asian/Asian British: Other Asian Person 3	Asian/Asian British: Other Asian Person 4	Asian/Asian British: Other Asian Person 5	Asian/Asian British: Other Asian Person 6	Asian/Asian British: Other Asian Person 7	Asian/Asian British: Other Asian Person 8
Black/African/Caribbean/Black British: African	Black/African/Caribbean/Black British: African Person 1	Black/African/Caribbean/Black British: African Person 2	Black/African/Caribbean/Black British: African Person 3	Black/African/Caribbean/Black British: African Person 4	Black/African/Caribbean/Black British: African Person 5	Black/African/Caribbean/Black British: African Person 6	Black/African/Caribbean/Black British: African Person 7	Black/African/Caribbean/Black British: African Person 8
Black/African/Caribbean/Black British: Caribbean	Black/African/Caribbean/Black British: Caribbean Person 1	Black/African/Caribbean/Black British: Caribbean Person 2	Black/African/Caribbean/Black British: Caribbean Person 3	Black/African/Caribbean/Black British: Caribbean Person 4	Black/African/Caribbean/Black British: Caribbean Person 5	Black/African/Caribbean/Black British: Caribbean Person 6	Black/African/Caribbean/Black British: Caribbean Person 7	Black/African/Caribbean/Black British: Caribbean Person 8
Black/African/Caribbean/Black British: Other Black	Black/African/Caribbean/Black British: Other Black Person 1	Black/African/Caribbean/Black British: Other Black Person 2	Black/African/Caribbean/Black British: Other Black Person 3	Black/African/Caribbean/Black British: Other Black Person 4	Black/African/Caribbean/Black British: Other Black Person 5	Black/African/Caribbean/Black British: Other Black Person 6	Black/African/Caribbean/Black British: Other Black Person 7	Black/African/Caribbean/Black British: Other Black Person 8
Mixed/multiple ethnic group: White and Black Caribbean	Mixed/multiple ethnic group: White and Black Caribbean Person 1	Mixed/multiple ethnic group: White and Black Caribbean Person 2	Mixed/multiple ethnic group: White and Black Caribbean Person 3	Mixed/multiple ethnic group: White and Black Caribbean Person 4	Mixed/multiple ethnic group: White and Black Caribbean Person 5	Mixed/multiple ethnic group: White and Black Caribbean Person 6	Mixed/multiple ethnic group: White and Black Caribbean Person 7	Mixed/multiple ethnic group: White and Black Caribbean Person 8
Mixed/multiple ethnic group: White and Black African	Mixed/multiple ethnic group: White and Black African Person 1	Mixed/multiple ethnic group: White and Black African Person 2	Mixed/multiple ethnic group: White and Black African Person 3	Mixed/multiple ethnic group: White and Black African Person 4	Mixed/multiple ethnic group: White and Black African Person 5	Mixed/multiple ethnic group: White and Black African Person 6	Mixed/multiple ethnic group: White and Black African Person 7	Mixed/multiple ethnic group: White and Black African Person 8
Mixed/multiple ethnic group: White and Asian	Mixed/multiple ethnic group: White and Asian Person 1	Mixed/multiple ethnic group: White and Asian Person 2	Mixed/multiple ethnic group: White and Asian Person 3	Mixed/multiple ethnic group: White and Asian Person 4	Mixed/multiple ethnic group: White and Asian Person 5	Mixed/multiple ethnic group: White and Asian Person 6	Mixed/multiple ethnic group: White and Asian Person 7	Mixed/multiple ethnic group: White and Asian Person 8
Mixed/multiple ethnic group: Other Mixed	Mixed/multiple ethnic group: Other Mixed Person 1	Mixed/multiple ethnic group: Other Mixed Person 2	Mixed/multiple ethnic group: Other Mixed Person 3	Mixed/multiple ethnic group: Other Mixed Person 4	Mixed/multiple ethnic group: Other Mixed Person 5	Mixed/multiple ethnic group: Other Mixed Person 6	Mixed/multiple ethnic group: Other Mixed Person 7	Mixed/multiple ethnic group: Other Mixed Person 8
Other ethnic group: Arab	Other ethnic group: Arab Person 1	Other ethnic group: Arab Person 2	Other ethnic group: Arab Person 3	Other ethnic group: Arab Person 4	Other ethnic group: Arab Person 5	Other ethnic group: Arab Person 6	Other ethnic group: Arab Person 7	Other ethnic group: Arab Person 8
Other ethnic group: Any other ethnic group	Other ethnic group: Any other ethnic group Person 1	Other ethnic group: Any other ethnic group Person 2	Other ethnic group: Any other ethnic group Person 3	Other ethnic group: Any other ethnic group Person 4	Other ethnic group: Any other ethnic group Person 5	Other ethnic group: Any other ethnic group Person 6	Other ethnic group: Any other ethnic group Person 7	Other ethnic group: Any other ethnic group Person 8

Question Title

* 6. Do you or anyone else living in your home have a disability? Please start with yourself and then record for the oldest person to the youngest, making sure that you have answered for each member of your household.

	Person 1	Person 2	Person 3	Person 4	Person 5	Person 6	Person 7	Person 8
Yes	Yes Person 1	Yes Person 2	Yes Person 3	Yes Person 4	Yes Person 5	Yes Person 6	Yes Person 7	Yes Person 8
No	No Person 1	No Person 2	No Person 3	No Person 4	No Person 5	No Person 6	No Person 7	No Person 8
Prefer not to say	Prefer not to say Person 1	Prefer not to say Person 2	Prefer not to say Person 3	Prefer not to say Person 4	Prefer not to say Person 5	Prefer not to say Person 6	Prefer not to say Person 7	Prefer not to say Person 8

Question Title

* 7. Do you or anyone else living in your home have any of the following needs? Please start with yourself and then record for the oldest person to the youngest, making sure that you have answered for each member of your household.

	Person 1	Person 2	Person 3	Person 4	Person 5	Person 6	Person 7	Person 8
None Apply	None Apply Person 1	None Apply Person 2	None Apply Person 3	None Apply Person 4	None Apply Person 5	None Apply Person 6	None Apply Person 7	None Apply Person 8
Frail Elderly	Frail Elderly Person 1	Frail Elderly Person 2	Frail Elderly Person 3	Frail Elderly Person 4	Frail Elderly Person 5	Frail Elderly Person 6	Frail Elderly Person 7	Frail Elderly Person 8
Physical disability	Physical disability Person 1	Physical disability Person 2	Physical disability Person 3	Physical disability Person 4	Physical disability Person 5	Physical disability Person 6	Physical disability Person 7	Physical disability Person 8
Learning disability	Learning disability Person 1	Learning disability Person 2	Learning disability Person 3	Learning disability Person 4	Learning disability Person 5	Learning disability Person 6	Learning disability Person 7	Learning disability Person 8
Life limiting health condition	Life limiting health condition Person 1	Life limiting health condition Person 2	Life limiting health condition Person 3	Life limiting health condition Person 4	Life limiting health condition Person 5	Life limiting health condition Person 6	Life limiting health condition Person 7	Life limiting health condition Person 8
Deaf or hard of hearing	Deaf or hard of hearing Person 1	Deaf or hard of hearing Person 2	Deaf or hard of hearing Person 3	Deaf or hard of hearing Person 4	Deaf or hard of hearing Person 5	Deaf or hard of hearing Person 6	Deaf or hard of hearing Person 7	Deaf or hard of hearing Person 8
Blind or with sight impairment	Blind or with sight impairment Person 1	Blind or with sight impairment Person 2	Blind or with sight impairment Person 3	Blind or with sight impairment Person 4	Blind or with sight impairment Person 5	Blind or with sight impairment Person 6	Blind or with sight impairment Person 7	Blind or with sight impairment Person 8
Mental health problem	Mental health problem Person 1	Mental health problem Person 2	Mental health problem Person 3	Mental health problem Person 4	Mental health problem Person 5	Mental health problem Person 6	Mental health problem Person 7	Mental health problem Person 8
Vulnerable young people and children leaving care	Vulnerable young people and children leaving care Person 1	Vulnerable young people and children leaving care Person 2	Vulnerable young people and children leaving care Person 3	Vulnerable young people and children leaving care Person 4	Vulnerable young people and children leaving care Person 5	Vulnerable young people and children leaving care Person 6	Vulnerable young people and children leaving care Person 7	Vulnerable young people and children leaving care Person 8
Severe long term illness	Severe long term illness Person 1	Severe long term illness Person 2	Severe long term illness Person 3	Severe long term illness Person 4	Severe long term illness Person 5	Severe long term illness Person 6	Severe long term illness Person 7	Severe long term illness Person 8
Other	Other Person 1	Other Person 2	Other Person 3	Other Person 4	Other Person 5	Other Person 6	Other Person 7	Other Person 8

Other (please specify)

Question Title

* 8. What is the faith/religion of members of your household? Please start with yourself and then record for the oldest person to the youngest, making sure that you have answered for each member of your household.

	Person 1	Person 2	Person 3	Person 4	Person 5	Person 6	Person 7	Person 8
Christian	Christian Person 1	Christian Person 2	Christian Person 3	Christian Person 4	Christian Person 5	Christian Person 6	Christian Person 7	Christian Person 8
Buddhist	Buddhist Person 1	Buddhist Person 2	Buddhist Person 3	Buddhist Person 4	Buddhist Person 5	Buddhist Person 6	Buddhist Person 7	Buddhist Person 8
Hindu	Hindu Person 1	Hindu Person 2	Hindu Person 3	Hindu Person 4	Hindu Person 5	Hindu Person 6	Hindu Person 7	Hindu Person 8
Jewish	Jewish Person 1	Jewish Person 2	Jewish Person 3	Jewish Person 4	Jewish Person 5	Jewish Person 6	Jewish Person 7	Jewish Person 8
Muslim	Muslim Person 1	Muslim Person 2	Muslim Person 3	Muslim Person 4	Muslim Person 5	Muslim Person 6	Muslim Person 7	Muslim Person 8
Sikh	Sikh Person 1	Sikh Person 2	Sikh Person 3	Sikh Person 4	Sikh Person 5	Sikh Person 6	Sikh Person 7	Sikh Person 8
Other	Other Person 1	Other Person 2	Other Person 3	Other Person 4	Other Person 5	Other Person 6	Other Person 7	Other Person 8
No religion	No religion Person 1	No religion Person 2	No religion Person 3	No religion Person 4	No religion Person 5	No religion Person 6	No religion Person 7	No religion Person 8
Atheist	Atheist Person 1	Atheist Person 2	Atheist Person 3	Atheist Person 4	Atheist Person 5	Atheist Person 6	Atheist Person 7	Atheist Person 8
Prefer not to say	Prefer not to say Person 1	Prefer not to say Person 2	Prefer not to say Person 3	Prefer not to say Person 4	Prefer not to say Person 5	Prefer not to say Person 6	Prefer not to say Person 7	Prefer not to say Person 8

Other (please specify)

Question Title

* 9. What is the Sexual Orientation of your household members? (This question only applies to people living in your home over 16 years old) Please start with yourself and then record for the oldest person to the youngest, making sure that you have answered for each member of your household.

	Person 1	Person 2	Person 3	Person 4	Person 5	Person 6	Person 7	Person 8
Heterosexual/Straight	Heterosexual/Straight Person 1	Heterosexual/Straight Person 2	Heterosexual/Straight Person 3	Heterosexual/Straight Person 4	Heterosexual/Straight Person 5	Heterosexual/Straight Person 6	Heterosexual/Straight Person 7	Heterosexual/Straight Person 8
Gay/Lesbian	Gay/Lesbian Person 1	Gay/Lesbian Person 2	Gay/Lesbian Person 3	Gay/Lesbian Person 4	Gay/Lesbian Person 5	Gay/Lesbian Person 6	Gay/Lesbian Person 7	Gay/Lesbian Person 8
Bisexual	Bisexual Person 1	Bisexual Person 2	Bisexual Person 3	Bisexual Person 4	Bisexual Person 5	Bisexual Person 6	Bisexual Person 7	Bisexual Person 8
Other	Other Person 1	Other Person 2	Other Person 3	Other Person 4	Other Person 5	Other Person 6	Other Person 7	Other Person 8
Prefer not to say	Prefer not to say Person 1	Prefer not to say Person 2	Prefer not to say Person 3	Prefer not to say Person 4	Prefer not to say Person 5	Prefer not to say Person 6	Prefer not to say Person 7	Prefer not to say Person 8

Question Title

* 10. What is the legal marital or same sex civil partnerships status of those who live in your household? Please start with yourself and then record for the oldest person to the youngest. (This question only applies to people living in your home over 16 years old)

	Person 1	Person 2	Person 3	Person 4	Person 5	Person 6	Person 7	Person 8
Never married and never registered a sex civil partnership	Never married and never registered a sex civil partnership Person 1	Never married and never registered a sex civil partnership Person 2	Never married and never registered a sex civil partnership Person 3	Never married and never registered a sex civil partnership Person 4	Never married and never registered a sex civil partnership Person 5	Never married and never registered a sex civil partnership Person 6	Never married and never registered a sex civil partnership Person 7	Never married and never registered a sex civil partnership Person 8
Married	Married Person 1	Married Person 2	Married Person 3	Married Person 4	Married Person 5	Married Person 6	Married Person 7	Married Person 8
In a registered same-sex civil partnership	In a registered same-sex civil partnership Person 1	In a registered same-sex civil partnership Person 2	In a registered same-sex civil partnership Person 3	In a registered same-sex civil partnership Person 4	In a registered same-sex civil partnership Person 5	In a registered same-sex civil partnership Person 6	In a registered same-sex civil partnership Person 7	In a registered same-sex civil partnership Person 8
Separated, but still legally married	Separated, but still legally married Person 1	Separated, but still legally married Person 2	Separated, but still legally married Person 3	Separated, but still legally married Person 4	Separated, but still legally married Person 5	Separated, but still legally married Person 6	Separated, but still legally married Person 7	Separated, but still legally married Person 8
Separated, but still legally in a same sex civil partnership	Separated, but still legally in a same sex civil partnership Person 1	Separated, but still legally in a same sex civil partnership Person 2	Separated, but still legally in a same sex civil partnership Person 3	Separated, but still legally in a same sex civil partnership Person 4	Separated, but still legally in a same sex civil partnership Person 5	Separated, but still legally in a same sex civil partnership Person 6	Separated, but still legally in a same sex civil partnership Person 7	Separated, but still legally in a same sex civil partnership Person 8
Divorced	Divorced Person 1	Divorced Person 2	Divorced Person 3	Divorced Person 4	Divorced Person 5	Divorced Person 6	Divorced Person 7	Divorced Person 8
Formerly in a same-sex civil partnership which is now legally dissolved	Formerly in a same-sex civil partnership which is now legally dissolved Person 1	Formerly in a same-sex civil partnership which is now legally dissolved Person 2	Formerly in a same-sex civil partnership which is now legally dissolved Person 3	Formerly in a same-sex civil partnership which is now legally dissolved Person 4	Formerly in a same-sex civil partnership which is now legally dissolved Person 5	Formerly in a same-sex civil partnership which is now legally dissolved Person 6	Formerly in a same-sex civil partnership which is now legally dissolved Person 7	Formerly in a same-sex civil partnership which is now legally dissolved Person 8
Widowed	Widowed Person 1	Widowed Person 2	Widowed Person 3	Widowed Person 4	Widowed Person 5	Widowed Person 6	Widowed Person 7	Widowed Person 8
Surviving partner from a same-sex civil partnership	Surviving partner from a same-sex civil partnership Person 1	Surviving partner from a same-sex civil partnership Person 2	Surviving partner from a same-sex civil partnership Person 3	Surviving partner from a same-sex civil partnership Person 4	Surviving partner from a same-sex civil partnership Person 5	Surviving partner from a same-sex civil partnership Person 6	Surviving partner from a same-sex civil partnership Person 7	Surviving partner from a same-sex civil partnership Person 8
Prefer not to say	Prefer not to say Person 1	Prefer not to say Person 2	Prefer not to say Person 3	Prefer not to say Person 4	Prefer not to say Person 5	Prefer not to say Person 6	Prefer not to say Person 7	Prefer not to say Person 8

Question Title

* 11. What is the main language spoken in your household?

English

Somali

Punjabi

Urdu

Gujarati

Other (please specify)

Question Title

* 12. If English is not the main language of people living in your home, please rate on a scale of 1 to 5 your household's ability to converse in English? With 1 being low and 5 being high.

	1	2	3	4	5
Spoken English	Spoken English 1	Spoken English 2	Spoken English 3	Spoken English 4	Spoken English 5
Written English	Written English 1	Written English 2	Written English 3	Written English 4	Written English 5

Question Title

* 13. Which of the following types of economic activity applies to members of your household? (Only applies to people living in your home over 16 years old, Starting with yourself and then the oldest person to the youngest)

	Person 1	Person 2	Person 3	Person 4	Person 5	Person 6	Person 7	Person 8
Employed Full Time	Employed Full Time Person 1	Employed Full Time Person 2	Employed Full Time Person 3	Employed Full Time Person 4	Employed Full Time Person 5	Employed Full Time Person 6	Employed Full Time Person 7	Employed Full Time Person 8
Employed Part Time	Employed Part Time Person 1	Employed Part Time Person 2	Employed Part Time Person 3	Employed Part Time Person 4	Employed Part Time Person 5	Employed Part Time Person 6	Employed Part Time Person 7	Employed Part Time Person 8
Self-employed Full Time	Self-employed Full Time Person 1	Self-employed Full Time Person 2	Self-employed Full Time Person 3	Self-employed Full Time Person 4	Self-employed Full Time Person 5	Self-employed Full Time Person 6	Self-employed Full Time Person 7	Self-employed Full Time Person 8
Self-employed Part Time	Self-employed Part Time Person 1	Self-employed Part Time Person 2	Self-employed Part Time Person 3	Self-employed Part Time Person 4	Self-employed Part Time Person 5	Self-employed Part Time Person 6	Self-employed Part Time Person 7	Self-employed Part Time Person 8
On government supported training programme	On government supported training programme Person 1	On government supported training programme Person 2	On government supported training programme Person 3	On government supported training programme Person 4	On government supported training programme Person 5	On government supported training programme Person 6	On government supported training programme Person 7	On government supported training programme Person 8
Student/full time education/school	Student/full time education/school Person 1	Student/full time education/school Person 2	Student/full time education/school Person 3	Student/full time education/school Person 4	Student/full time education/school Person 5	Student/full time education/school Person 6	Student/full time education/school Person 7	Student/full time education/school Person 8
Unemployed, available for work	Unemployed, available for work Person 1	Unemployed, available for work Person 2	Unemployed, available for work Person 3	Unemployed, available for work Person 4	Unemployed, available for work Person 5	Unemployed, available for work Person 6	Unemployed, available for work Person 7	Unemployed, available for work Person 8
Permanently sick/disabled	Permanently sick/disabled Person 1	Permanently sick/disabled Person 2	Permanently sick/disabled Person 3	Permanently sick/disabled Person 4	Permanently sick/disabled Person 5	Permanently sick/disabled Person 6	Permanently sick/disabled Person 7	Permanently sick/disabled Person 8
Retired	Retired Person 1	Retired Person 2	Retired Person 3	Retired Person 4	Retired Person 5	Retired Person 6	Retired Person 7	Retired Person 8
Looking after the home	Looking after the home Person 1	Looking after the home Person 2	Looking after the home Person 3	Looking after the home Person 4	Looking after the home Person 5	Looking after the home Person 6	Looking after the home Person 7	Looking after the home Person 8
Prefer not to say	Prefer not to say Person 1	Prefer not to say Person 2	Prefer not to say Person 3	Prefer not to say Person 4	Prefer not to say Person 5	Prefer not to say Person 6	Prefer not to say Person 7	Prefer not to say Person 8

Other (please specify)

Question Title

* 14. Which of the following apply to you?

I am currently employed and happy where I work

I am actively looking for work

I want a job that can fit into my family/childcare needs

I want to train and improve my skills to get a better job

I have little interest in getting a job

I have never worked and am still looking

Question Title

* 15. Do you feel any the following are barriers to you accessing employment? (Please tick all answers that apply or move to the next question if they do not apply)

I don't feel I have any barriers to accessing employment

Lack of affordable childcare

Lack of suitable experience

Lack of suitable qualifications

Concerns around not getting enough salary to make working viable

Getting work that fits into my care responsibilities

Lack of language skills

My disability

Preconceived perceptions of me by employers

Other (please specify)

Question Title

* 16. Do you have any of the following skills/qualifications? (Please tick all qualifications that apply)

GCSEs

A Levels

Degree

Post Graduate Degree/Diploma

BTEC Entry Level

Vocational Qualifications Level 1

Vocational Qualifications Level 2

Vocational Qualifications Level 3

None of the above

Other (please specify)

Question Title

* 17. Which of the following basic skills would you like some support with? (Please tick all responses that apply or move to the next question if they do not apply)

Language (English as a second language)

Reading

Writing

Numeracy

IT/Digital Skills

Other (please specify)

Question Title

* 18. Which of the following bandings does your annual household income fall within?

Less than £10,000

£10,000 to £15,000

£15,000 to £20,000

£20,000 to £25,000

£25,000-£30,000

£30,000 to £35,000

More than £35,000

Prefer not to say

Question Title

* 19. Are you or anyone else living in you home in receipt of benefit?

Yes

Question Title

* 20. If you answered Yes to the question above which of the following benefits apply? Please select all that are relevant, if you answered no to the question above please skip this question)

Housing Benefit

Child Tax Credit

Job Seekers Allowance (JSA)

Personal Independence Payment (PIP)

Universal Credit

Other (please specify)

Question Title

* 21. Do you have sufficient income in your household to meet the following?

	Yes	No
To fuel your home	To fuel your home Yes	To fuel your home No
To feed your household	To feed your household Yes	To feed your household No
To meet costs in general	To meet costs in general Yes	To meet costs in general No

Question Title

* 22. Would you like support with financial planning?

Yes

Question Title

* 23. Do you bank or shop online?

Yes

If No would you like help in setting it up? (Please indicate Yes or No)

Question Title

* 24. How would you like to receive information from us? Please tell us on a scale of 1 to 5 your preferences for each option, with 1 being low and 5 being high.

	1	2	3	4	5
Email	Email 1	Email 2	Email 3	Email 4	Email 5
Text	Text 1	Text 2	Text 3	Text 4	Text 5
Letter	Letter 1	Letter 2	Letter 3	Letter 4	Letter 5
Telephone	Telephone 1	Telephone 2	Telephone 3	Telephone 4	Telephone 5
Online Portal	Online Portal 1	Online Portal 2	Online Portal 3	Online Portal 4	Online Portal 5
Social Media	Social Media 1	Social Media 2	Social Media 3	Social Media 4	Social Media 5
Face to Face	Face to Face 1	Face to Face 2	Face to Face 3	Face to Face 4	Face to Face 5

Question Title

* 25. Would you like to get involved in ensuring that INQUILAB improves its performance and services for residents?

Yes

Question Title

* 26. If yes, how would you like to get involved? Please tick all that apply

Tenants Associations

Resident Panels

Community Events

Other (please specify)

Question Title

* 27. Please tell us if you disagree or agree with the following statements?

	Disagree strongly	Disagree	Neither disagree nor agree	Agree	Agree strongly
I am happy where I live	I am happy where I live Disagree strongly	I am happy where I live Disagree	I am happy where I live Neither disagree nor agree	I am happy where I live Agree	I am happy where I live Agree strongly
I see myself moving on in the next year	I see myself moving on in the next year Disagree strongly	I see myself moving on in the next year Disagree	I see myself moving on in the next year Neither disagree nor agree	I see myself moving on in the next year Agree	I see myself moving on in the next year Agree strongly
I’m looking to downsize	I’m looking to downsize Disagree strongly	I’m looking to downsize Disagree	I’m looking to downsize Neither disagree nor agree	I’m looking to downsize Agree	I’m looking to downsize Agree strongly
I am interested in home ownership	I am interested in home ownership Disagree strongly	I am interested in home ownership Disagree	I am interested in home ownership Neither disagree nor agree	I am interested in home ownership Agree	I am interested in home ownership Agree strongly
My home is sufficient for my household’s needs	My home is sufficient for my household’s needs Disagree strongly	My home is sufficient for my household’s needs Disagree	My home is sufficient for my household’s needs Neither disagree nor agree	My home is sufficient for my household’s needs Agree	My home is sufficient for my household’s needs Agree strongly

(Please specify)

Question Title

* 28. Of the following service priorities what is most important to you? Please rate on a scale of 1 to 5 with 1 being least important and 5 being most important.

	1	2	3	4	5
Overall quality of my home	Overall quality of my home 1	Overall quality of my home 2	Overall quality of my home 3	Overall quality of my home 4	Overall quality of my home 5
Repairs and maintenance	Repairs and maintenance 1	Repairs and maintenance 2	Repairs and maintenance 3	Repairs and maintenance 4	Repairs and maintenance 5
Planned works	Planned works 1	Planned works 2	Planned works 3	Planned works 4	Planned works 5
Value for money in your rent	Value for money in your rent 1	Value for money in your rent 2	Value for money in your rent 3	Value for money in your rent 4	Value for money in your rent 5
Value for money in your service charge	Value for money in your service charge 1	Value for money in your service charge 2	Value for money in your service charge 3	Value for money in your service charge 4	Value for money in your service charge 5
Making sure my home is warm	Making sure my home is warm 1	Making sure my home is warm 2	Making sure my home is warm 3	Making sure my home is warm 4	Making sure my home is warm 5

Question Title

* 29. Thinking about where you live what do you think are the most important priorities that need to be addressed? Please rate the following on a scale of 1 to 5 with 1 being least important and 5 being most important.

	1	2	3	4	5
Maintaining the cleanliness and presentation of the neighbourhood	Maintaining the cleanliness and presentation of the neighbourhood 1	Maintaining the cleanliness and presentation of the neighbourhood 2	Maintaining the cleanliness and presentation of the neighbourhood 3	Maintaining the cleanliness and presentation of the neighbourhood 4	Maintaining the cleanliness and presentation of the neighbourhood 5
Tackling Anti-Social Behaviour	Tackling Anti-Social Behaviour 1	Tackling Anti-Social Behaviour 2	Tackling Anti-Social Behaviour 3	Tackling Anti-Social Behaviour 4	Tackling Anti-Social Behaviour 5
Feeling safe in your home	Feeling safe in your home 1	Feeling safe in your home 2	Feeling safe in your home 3	Feeling safe in your home 4	Feeling safe in your home 5
Feeling safe in your neighbourhood	Feeling safe in your neighbourhood 1	Feeling safe in your neighbourhood 2	Feeling safe in your neighbourhood 3	Feeling safe in your neighbourhood 4	Feeling safe in your neighbourhood 5
Improving the local environment	Improving the local environment 1	Improving the local environment 2	Improving the local environment 3	Improving the local environment 4	Improving the local environment 5
Supporting people into employment	Supporting people into employment 1	Supporting people into employment 2	Supporting people into employment 3	Supporting people into employment 4	Supporting people into employment 5
Involving residents in decision making	Involving residents in decision making 1	Involving residents in decision making 2	Involving residents in decision making 3	Involving residents in decision making 4	Involving residents in decision making 5
Improving information and communication	Improving information and communication 1	Improving information and communication 2	Improving information and communication 3	Improving information and communication 4	Improving information and communication 5

Question Title

* 30. Which of the following qualities do you feel are important to you being a resident of a BME Housing Association. Please tick all that apply

A Housing Association that is sensitive to my needs

A Housing Association that is non-judgmental on grounds of my ethnicity

A Housing Association that seeks to tackle discrimination

A Housing Association that seeks to uphold equal opportunities, diversity and inclusion

A Housing Association that lives and breathes its commitment to address the housing needs of BAME residents

Other please specify