Long Stay Application Form - Spectrum Housing Group

FOR ALL RESIDENTS TO COMPLETE: PART BYou may feel some of these questions are not directly relevant to the allocation of accommodation;however this information may be kept and used to help the Association to monitor and developservices that ensure full equality of opportunity.We recommend that you read the leaflet “About the information we hold about you” and youconsent to the processing of information as described in that leaflet. If you require a copy pleasecontact 08007837837 or download from our website www.spectrumhousing.co.ukAs a resident how do you wish us to contact you?Preferred contact method-Email, Phone Post Visit(Please circle one)Preferred contact time(Please delete the hours not suitable)Before 8am Between 8am-1pm Between 1pm-5pm After 5pmEQUALITY AND DIVERSITY1) How would you describe yourself? (Please tick one box)White: British IrishAny other White backgroundAsian or Asian British: Bangladeshi IndianPakistaniAny other Asian backgroundBlack or Black British: African CaribbeanAny other BlackbackgroundChinese:Mixed: White and Asian White and Black African White and Black Caribbean Any other mixed backgroundAny other Ethnic Group: Please specify2) Do you consider yourself to have a disability? Yes / NoIf yes, what is the nature of your disability?Physical Impairment Wheelchair User Mobility Impairment OtherSensory Impairment Sight HearingOtherMental Impairment Learning disability Are you registereddisabled?OtherYes / No