All fields are mandatory *
Title*
Surname*
First name*
Address*
Postcode*
Contact number*
Email Address*
Are you satisfied with the overall service provided by LSH?*
Are you satisfied with you accommodation?*
Are you satisfied with the general condition of the property?*
Does the rent provide good value for money?*
Are you satisfied with the repairs and maintenance service?*
Are you satisfied with the neighbourhood as a place to live?*
Do you feel the association is good at involving you in discussions that affect you as a resident?*
Gender* Please Select Male Female
Ethnic Origin* Please Select White British White lrish White Other Mixed White/Black Caribbean Mixed White/Black African Mixed White/Asian Mixed Other Asian/Asian-British Indian Asian/ Asian-British Pakistani Asian/ Asian-British Bangladeshi Asian/Asian-British Other Black/ Black-British Caribbean Black/ Black-British African Black/ Black-British Other Chinese Gypsy /Romany /lrish Traveller Other Refused
Language* Please Select Arabic Armenian Bengali Calaba Cantonese Creole Croatian Dutch English Farsi German Gujarati Hindi Hungarian Ibo Igbo Italian Kiaswaluly Kurdish Ghanaian Greek Persian Philipino Polish Portuguese Punjabi Serbian Somali Spanish Tagalog Tamil Turkish Twi Urdu Yoruba Other Asian Other African Other European
Religious Affiliation* Please Select Buddhist Christian Hinduuddhist Jewish Muslim Sikh Other Religion Prefer not to say
Sexual Orientation* Please Select Bisexual Gay Heterosexual Lesbian Prefer not to say
Date of Birth (dd/mm/yyyy)*