Northwards Housing

A fair and equal service

Online form

We want to treat you and all other tenants fairly and with respect.

So we are asking every tenant to tell us about themselves and how they want to be treated.

By answering a few simple questions you can help us give you a fair and equal service. And you could win stylish improvements to your home!

The information you give us is confidential. We will only share your answers in the 'communication needs' section with our front-line staff to help us give you a better service. It's as simple as that.

You don't have to answer all the questions, but the more you do, the better we can make our service to you.

Please do not send more than one form; we can only accept one entry from each tenant.

Many Thanks!

YOUR DETAILS * You cannot leave these parts blank
Surname *
First name *
Address
House/Flat number *
Road/Court
Area
Postcode help *
Daytime phone number (if none, put 'none') *
Email address If you want us to contact you this way.

Ethnicity Please tell us your ethnic background.
White
British Irish
Other white background (please state)
Mixed
white and black Caribbean
white and black African
white and Asian
other mixed background (please state)
Asian or Asian British
Indian
Pakistan
Bangladeshi
Any other Asian background (please state)
Black or Black British
African
Caribbean
any other black background (please state)
Other ethnic background
Chinese
Vietnamese
Gypsy/Traveller
Other ethnic background (please state)

Do you consider yourself to be a refugee?
Yes
No

Gender male female
Other gender identity eg transsexual, transgender (please state)

Sexuality heterosexual/straight
gay man
gay woman/lesbian
bisexual
other (please state)

Religion/Belief Christian Buddhist Hindu Muslim Jewish Sikh None Other (please state)

Disability A disability is a physical or mental impairment that has a significant and long-term effect on a person's ability to carry out daily activities.

Do you consider yourself disabled?
Yes No

If 'Yes': to help us give you a fair and accessible service, please tell us the nature of your disability:

physical impairment
hearing impairment
visual impairment (that is not corrected by glasses or contact lenses)
speech impairment
severe disfigurement
mental health problems
learning disability
learning difficulties or literacy/numeracy needs
long-standing illness or health condition such as cancer, HIV/AIDS, diabetes, chronic heart disease or epilepsy (please say what)

other (please say what)

Communication needs Different people need different types of communication. For example, people with a visual impairment may need letters in large print. Or you may want to have another person there when we are doing work in your home.
Please fill in this section if you think we need to consider your individual needs when we contact you in future.

When we write to you
If you have difficulty reading English, or you would like information in another way, please tell us how you would like it.
Braille in large print on a CD face to face
Other (please tell us the details here)
I would like it sent to someone else (eg family member, carer)
(please give us their details here)

When we phone you
Would you like us to use:
typetalk an interpreter
If no-one in your house speaks English we can get an interpreter to translate the call. Which language do you speak?
Or, would you prefer to be contacted in another way? (please tell us the details here)

When we visit you
Is there anything we should know?
I need a British Sign Language (BSL) interpreter to be there
I need an interpreter who speaks my language. (please say which language)
I would like to know when you are coming so I can have someone else there with me.
I would like you to knock loudly and give me time to get to the door
Other (please tell say what)

Thank you for your answers. You may want to check them before you send the form. Good luck in the prize draw!

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Data Protection

The information you supply on this form will be sent to Northwards Housing. It will only be used to process your request for information or the service(s) described on this page. Any details you supply will be treated confidentially and will only be used in direct relation to work needed to carry out your request.

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A not-for-profit company managing City Council homes in North Manchester

A fair and equal service

Online form

Data Protection

Have your say