Page 1 - Tenant Census - Understanding Our Tenants

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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.

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

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

How many people live in your home?

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

Title (Mr, Miss, Mrs, Ms, Mx, Dr, etc)

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

Surname

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

First Name

Date of Birth (DD/MM.YYYY)

Person 1

Person 2

Person 3

Person 4

Person 5

Person 6

Date Moved In (DD/MM/YY)

Person 1

Person 2

Person 3

Person 4

Person 5

Person 6

Relationship to Tenant

Person 1

Person 2

Person 3

Person 4

Person 5

Person 6

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

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

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

Male

Female

Prefer Not To Say

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

Prefer Not To Say

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

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

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

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

Prefer not to say

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

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

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?

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

Prefer not to say

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:

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

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:

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

Yes

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

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

How many people in your household whose main language is:

English

Welsh

Other (including BSL, please state)

Prefer not to say

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

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

Tenant 1

Tenant 2

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

Tenant 1

Yes

Tenant 2

Yes

Tenant Census - Understanding Our Tenants

Tenant 1 Personal Details

Tenant 2 Personal Details

How many people live in your home?

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

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

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

Your Gender

Date of Birth (DD/MM.YYYY)

Date Moved In (DD/MM/YY)

Relationship to Tenant

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

White

Asian or Asian British

Mixed

Black or Black British

Other Ethnic Group

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

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

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

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

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

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

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?

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?

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.

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?

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:

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

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:

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

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

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

How many people in your household whose main language is:

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

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

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

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