Housing Application Form Page 3
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17Mobile number: ___________________________E-mail:____________________________
Address we should write to (if different):__________________________________________
_________________________________________________________________________
Ethnic code (see the codes on page 3):__________________________________________
Equality monitoring
Please help us to monitor the service we provide and the way we treat applications for
housing by filling in the details below. We need this information to make sure that everyone
receives fair and sensitive treatment according to their needs. We will keep information
confidential.
Please give the following information for everyone who will live with you.
Please use the codes below to tell us the ethnic code for everyone who will live with
you (see pages 3 and 4).
A. White
English, Scottish, Welsh, Northern Irish, British: A1
Irish: A2
Gypsy, Romany, Irish Traveller: A18
Other: A3
_________________________________________________________________________
B. Mixed
White and Black Caribbean: B4
White and Black African: B5
White and Asian: B6
Other: B7
_________________________________________________________________________
C. Asian or Asian British
Indian: C8
Pakistani: C9
Bangladeshi: C10
Chinese: C15
Other: C11
_________________________________________________________________________
D. Black or black British
Caribbean: D12
African: D13
Other: D14
_________________________________________________________________________
E. Other ethnic group
Arab: E19
Other: E16
_________________________________________________________________________
F. Refused F17
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Are you a gypsy or a traveller? Yes
No
Prefer not to say
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3 What is your religion or belief?
(please tick the appropriate box)
Buddhist
Christian
Hindu
Jewish
Muslim
Sikh
None
Any other - please give details
____________________________________________
Prefer not to say
----------------------------------------------------------------------------------------------------------------
4 What is your sexuality?
(please tick the appropriate box)
Heterosexual (straight)
Gay man
Lesbian
Bisexual
Prefer not to say
Twitter@tuntumHA
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