Tenant Census - Understanding Our Tenants

Merthyr Tydfil Housing Association wants to eliminate discrimination and promote equal opportunities. Collecting the following information can help us achieve this. We monitor and analyse diversity information to make sure that our processes are fair, transparent and promote equality of opportunities for all service users. We want to know if everyone can access our services equally. Your cooperation enables us to plan and deliver services more effectively to individual contract holders and service user’s needs. Any information on this form will be treated confidentially, in accordance with the General Data Protection Regulations and will be used for statistical purposes only. Our privacy notice will tell you more about how and why we use this information. You can access this on our website www.mtha.org.uk.

Examples of what we will use your information for include:

Providing information in a different language and telephoning or texting instead of sending letters.
Providing large print letters

If you require this form in another language or format or need assistance completing the form, please contact the association on 01685 352800 and speak with a member of the housing team.

1. Tenant 1 Personal Details

Title (Mr, Miss, Mrs, Ms, Mx, Dr, etc.)
Surname
First Name
Date of Birth (DD/MM/YYYY)
Gender (male, female, non-binary, other, prefer not to say))
Is your sex the same as that in which you were born with? Yes/No
Home Phone Number
Mobile Phone Number
Which is your preferred contact number?
Email Address

2. Tenant 2 Personal Details

Title (Mr, Miss, Mrs, Ms, Mx, Dr, etc.)
Surname
First Name
Date of Birth (DD/MM/YYYY)
Gender (male, female, non-binary, other, prefer not to say)
Is your sex the same as that in which you were born with? Yes/No
Home Phone Number
Mobile Phone Number
Which is your preferred contact number?
Email Address

3. How many people live in your home?

4. Please tell us about any other people that live with you.

	Person 1	Person 2	Person 3	Person 4	Person 5	Person 6
Title (Mr, Miss, Mrs, Ms, Mx, Dr, etc)	Title (Mr, Miss, Mrs, Ms, Mx, Dr, etc) Person 1	Title (Mr, Miss, Mrs, Ms, Mx, Dr, etc) Person 2	Title (Mr, Miss, Mrs, Ms, Mx, Dr, etc) Person 3	Title (Mr, Miss, Mrs, Ms, Mx, Dr, etc) Person 4	Title (Mr, Miss, Mrs, Ms, Mx, Dr, etc) Person 5	Title (Mr, Miss, Mrs, Ms, Mx, Dr, etc) Person 6

5. Please tell us about any other people that live with you.

	Person 1	Person 2	Person 3	Person 4	Person 5	Person 6
Surname	Surname Person 1	Surname Person 2	Surname Person 3	Surname Person 4	Surname Person 5	Surname Person 6

6. Please tell us about any other people that live with you.

	Person 1	Person 2	Person 3	Person 4	Person 5	Person 6
First Name	First Name Person 1	First Name Person 2	First Name Person 3	First Name Person 4	First Name Person 5	First Name Person 6

7. Your Gender

	Person 1	Person 2	Person 3	Person 4	Person 5	Person 6
Male	Male Person 1	Male Person 2	Male Person 3	Male Person 4	Male Person 5	Male Person 6
Female	Female Person 1	Female Person 2	Female Person 3	Female Person 4	Female Person 5	Female Person 6
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
Other	Other Person 1	Other Person 2	Other Person 3	Other Person 4	Other Person 5	Other Person 6

8. Date of Birth (DD/MM.YYYY)

Person 1
Person 2
Person 3
Person 4
Person 5
Person 6

9. Date Moved In (DD/MM/YY)

Person 1
Person 2
Person 3
Person 4
Person 5
Person 6

10. Relationship to Tenant

Person 1
Person 2
Person 3
Person 4
Person 5
Person 6

11. For all those living in your home, please state number of people whose ethnicity applies.

White
British
Irish
Other
Asian or Asian British
Indian
Pakistani
Bangladeshi
Any other Asian background
Mixed
White and Black Caribbean
White and black African
White and Asian
Any other mixed background
Black or Black British
Caribbean
African
Any other black background
Other Ethnic Group
Chinese
Any other Ethnic Group
I do not wish to disclose my ethnic origin

12. For all those living in your home, please state the number of people whose national identity is:

British
Welsh
English
Scottish
Northern Irish
Prefer not to say
Other, please comment

13. For all those living in your home, please state the number of people whose sex is:

Male
Female
Prefer Not To Say

14. For those living in your home, please state the number of people whose gender is not the same as their registered sex at birth.

Yes
No
Prefer Not To Say

15. For those living in your home, please state the number of people whose sexuality is best described as:

Straight/ heterosexual
Gay or lesbian
Bisexual
Prefer not to say
Other sexual orientation, please comment

16. For those living in your home, how many belong to the following age groups?

15 or under
16-24
25-34
35-44
45-54
55-64
65-74
75 + years
Prefer not to say

17. For those living in your home, please tell us the number of people whose marital status is identified below:

Never married and never registered a civil partnership
Married
In a registered civil partnership
Separated, but still legally married
Separated, but still legally in a registered civil partnership
Divorced
Formally in a civil which is now legally dissolved
Widowed
Surviving partner from a registered civil partnership
Prefer not to say

18. Please tell us the number of people living in your home who has any physical or mental health conditions, illnesses or impairments lasting or expected to last 12 months or more?

Yes
No
Prefer not to say

19. Please tell us the number of people in your home, where any of these conditions, illnesses or impairments reduce their ability to carry out day to day activities?

Yes, a lot
Yes, a little
Not at all
Prefer not to say

20. It helps us to know whether we are reaching all disabled people. If you ticked “yes” above, please state how many people in your household have any of the following disabilities.

Deafness or hearing impairment
Blindness or vision impairment
Physical disability/impairment or mobility issues
Learning disability
Learning difficulty, such as dyslexia
Mental health condition, such as depression or schizophrenia
Social/communication impairment such as Asperger’s syndrome/other autistic spectrum disorder
Long term health condition such as cancer, HIV, diabetes, chronic heart disease or epilepsy
A disability, impairment or medical condition that is not listed above, please comment
Prefer not to say

21. Does anyone in your home look after, or give any help or support to anyone because they have long term physical or mental health conditions, illnesses, impairments, or problems related to old age?

No
Yes, 9 hours a week or less
Yes 10-19 hours a week
Yes 20-34 hours a week
Yes 35-49 hours a week
Yes 50 or more hours a week
Yes 50 or more hours a week
Prefer not to say

22. Please let us know if we can do anything to make it easier for you when staff or our contractors are visiting your home or when you are visiting our office. Please comment below, e.g. allow longer time to open the door, large print documents etc:

23. For all those living in your home, please tell us the number of people whose religion is as follows:

Buddhist
Christian (all denominations)
Hindu
Jewish
Muslim
Sikh
No religionAny other religion, please comment
Prefer not to say

24. Do you or any person who lives with you have a religious or cultural requirements that you would like us to be aware of when we visit your home or when you call into the office? If yes, please give details below:

25. Are you happy for us to give your details to our contractors and members of our Customer Service Teams? This will enable our contractors to contact you directly to arrange to carry out repairs and allow our Customer Service Teams to contact you for feedback on our services

26. How many people in your home would prefer to communicate through British Sign Language:

27. How many people in your home can understand, speak, or write Welsh?

Understand spoken Welsh
Speak Welsh
Read Welsh
Write Welsh
None of the above
Prefer not to say

28. How many people in your household whose main language is:

English
Welsh
Other (including BSL, please state)
Prefer not to say

29. If English is not your first language, how many people in your home can speak, understand, or write English?

Understand spoken English
Speak English
Read English
Write English
None of the above
Prefer not to say

30. If you would prefer the information you receive from us in any of the formats below, please tell us. Please tick all that apply.

	Yes	No
Large print	Large print Yes	Large print No
Braille	Braille Yes	Braille No
CD	CD Yes	CD No
Audio tape	Audio tape Yes	Audio tape No
Other language, please state	Other language, please state Yes	Other language, please state No

Other language

31. What is your preferred contact method. Where possible we will use this to contact you.

	Email	Letter	Mobile phone	Telephone	Text	Other please comment
Tenant 1	Tenant 1 Email	Tenant 1 Letter	Tenant 1 Mobile phone	Tenant 1 Telephone	Tenant 1 Text	Tenant 1 Other please comment
Tenant 2	Tenant 2 Email	Tenant 2 Letter	Tenant 2 Mobile phone	Tenant 2 Telephone	Tenant 2 Text	Tenant 2 Other please comment

32. I don’t wish to provide any of the information requested in this form.

	Yes
Tenant 1	Tenant 1 Yes
Tenant 2	Tenant 2 Yes