The 2010 census form

Where You Live

Please tell us your contact details so we can update our records.

You can find this on your rent statement.

Please include your postcode.

If you would like us to send your letters to a different address, please put it in the box below.

About You

Lead Customer

About Your Joint Tenant

Joint Tenant

Other People That Live With You

Forename Surname M/F Date Of Birth Relationship Date Moved In
1
2
3
4
5
6
7
8

The Disability Discrimination Act (1995) defines disability as a "physical or mental impairment which has a substansial and long termm adverse effect on a person's ability to carry out normal day to day activities".

Does any member of your household consider themselves to be disabled?

Tenants Other People That Live With You
You JT 1 2 3 4 5 6 7 8

The number should match the number of people the last section. Tick all that apply.

If you have answered yes to the last question, please tell us the nature of the disability for each person.

Tenants Other People That Live With You
You JT 1 2 3 4 5 6 7 8

Please tick as many boxes as apply for each person. The numbers here should also match the number of people the last section.

Do you, or any person that lives with you, have any disability related needs that you would like us to be aware of when we visit you at home or when you call in to your local Yorkshire Housing office?

Do you or anyone in your household have religious or cultural requirements that you would like us to be aware of when we visit you at your home or when you call in to your local Yorkshire Housing office?

If yes, please provide details.

Getting In Touch With You

Your Contact Details

Language Preference

If English is not your first language, which other language would you like us to communicate with you in?

Communication Requirements

To communicate with us, do you need any of the following?

Please tick all that apply.

Communication Preferences

If you would prefer the information you receive from us to be in an alternative format, please let us know.

Please tick all that apply.

Additional Services

We will do our best to meet your needs but it may not always be possible to do so.

Please tick all that apply.

Only visit me on the following days:

Getting In Touch With Your Joint Tenant

Joint Tenant's Contact Details

Language Preference

If English is not your first language, which other language would you like us to communicate with you in?

Communication Requirements

To communicate with us, do you need any of the following?

Please tick all that apply.

Communication Preferences

If you would prefer the information you receive from us to be in an alternative format, please let us know.

Please tick all that apply.

Additional Services

We will do our best to meet your needs but it may not always be possible to do so.

Please tick all that apply.

Only visit me on the following days:

Support For You In Your Home

Do you have a support worker, family member or friend who helps you with housing matters?

(continue to the next question)
(skip this section entirely)

Do you give your permission for us to discuss matters concerning your tenancy with this person?

(please fill in details below)
(continue to the next question)

Support For Your Joint Tenant In Your Home

Do you have a support worker, family member or friend who helps you with housing matters?

(continue to the next question)
(skip this section entirely)

Do you give your permission for us to discuss matters concerning your tenancy with this person?

(please fill in details below)
(continue to the next question)

Your Next of Kin

Joint Tenant's Next of Kin

Is there anything else you feel we should know to help us deliver our services to you. For example what time you drop of and pick up your children from school, if you work nights. Anything that you feel we should know.

Once you have filled in any missing data, please click the Submit button once, and then wait for confirmation that your information has arrived.