Do you live in Council housing or a property that is managed by Tamworth Borough Council?  Would you like to let Tamworth Borough Council know your views but you can't go to meetings?

	Name

	Address

	Postcode

	Email address

	Home or daytime telephone number

	Mobile Phone number

	I/we would like to be involved in the following ways (tick all that apply)
	Completing surveys (help can be provided)		Attending local estate walkabouts -"You said, we did"
	Receiving & commenting on proposals via email		Joining tenant and resident groups
	Attending discussion or focus groups		Attending fun days and local events
	Attending conferences /workshops		Carrying out surveys and inspections to check housing services
	Being added onto the Tenant Involvement Database

	I /we are available (tick all that apply)
	Mornings		Afternoons		Evening		weekends

	I /we have an interest in  (tick all that apply)
	Repairs and improvements (inside your home)		Equalities policies (ensuring services are accessible to all)
	Environmental improvements (outside your home)		Performance monitoring
	Grass cutting /maintenance of communal areas		Arrangements for resident involvement
	Neighbourhood services (caretaking/cleaning/neighbourhood wardens and gardening)		Leaseholder services
	Anti-social behaviour (noise /harassment /vandalism)		Sheltered housing services
	Budget, finance and rent setting		Services for young people
	production of Open House and other housing publicity

About You

	Ethnicity
	white -British		Mixed - Other		Black or Black British - African
	White - Irish		Asian or Asian British - Indian		Black - Other
	White -Other		Asian or Asian British -Bangladeshi		Chinese
	Mixed - White & Black Caribbean		Asian or Asian British - Pakistani		Other Ethnic group
	Mixed - White & Black African		Asian or Asian British - Other
	Mixed - White & Asian		Black or Black British  - Caribbean

	Disability
	Limited mobility		Speech impairment		Mental health problems
	Visual impairment		Learning disability		Other impairment (please state)
	Hearing impairment		Long term health problems /illness which limits the things you can do

	Religion
	Buddhist		Hindu		Muslim		None
	Christian		Jewish		Sikh		Other

	Gender
	Male		Female

	Age Which of the following does your current age fall into?
	Under 16		18 - 24		40 - 59		75 and over
	16 /17 year old		25 - 39		60 - 74

	Sexual orientation
	Heterosexual		Bisexual		Gay man		Gay woman /lesbian

	Household Which of the following best describes your household?
	1 Adult, under 60		2 Adults, both under 60		2 Adults, at least 1 over 60		1 parent family (at least one child under 16)
	1 Adult, over 60		2Adults, both over 60		2 parent family (at least one child under 16)		Other

	Date       (Please enter as the following format  19/04/2010)

Once registered you may be invited to information sessions to help you in your role.  For further information, contact the Tenant Participation Team on 01827 709448 or freephone 0800 183 0454 or email: tenantparticipation@ tamworth .gov.uk