* Your name

* Your address

* Your telephone number

* Your e-mail address

You can be involved in as much or as little as you wish. Please tick as many of the things below that you are interested in being consulted about.

Issues to do with customer service.

Issues affecting tenants with disabilities.

Issues affecting the community and environment (estate management).

Issues affecting black and ethnic minority tenants.

Issues to do with Housing Needs.

Issues to do with Leaseholders.

Issues affecting older people.

Issues to do with Tenant Service Authority (local standards and scrutiny).

Issues to do with repair and maintenance.

Issues affecting young people (for people aged 16-25).

I am interested in finding out more about the Tenant Representative Group.

I would like to talk to someone about joining or setting up a residents' association in my area.

I am interested in joining:

telephone surveys

postal surveys

the Reading Panel

the 'e-consultation' group

the Mystery Shopping group

We aim to provide a service that meets the needs of all tenants. Thiis is part of our commitment to providing fair and equal access to our housing services. By answering these questions, you will help us to do this. If you don't feel comfortable answering a question, it's ok to leave it blank.

Are you:

Male Female

What is your age?

16-24 25-34 35-44 45-54 55-59 60-64 65-74 75+

What is your ethnic group? (Please tick one box)

White British

English Scottish Welsh Other (please write):

White

Irish Other (please write):

Mixed

White and Black Caribbean White and Black African White and Asian
Other (please write):

Asian or Asian British

Indian Pakistani Bangladeshi Other (please write):

Black or Black British

Caribbean African Other (please write):

Chinese or Chinese British

Chinese Other (please write):

Travellers and Gypsies

Roma/Gypsy Traveller of Irish Heritage Other (please write):