Everyone Matters

Please complete the below information for all residents in your household, there are some questions which are optional but some are mandatory (these are indicated by a *) to ensure we are able to accurately update our records.

FAQs and details on why we are collecting this data can be found here: Everyone Matters - FAQs - Solihull Community Housing

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Main Tenant 1

Title

First Name *

Middle Name(s)

Surname(s) *

Date of Birth *

Sex

Male
Female
Non Binary

Gender Identity

Pronouns

He/Him
She/her
They/them
Other

Please enter your preferred pronouns here

Ethnicity

Nationality

British
Other

Add your nationality here

What is your main language?

English
Other

Add your main language here

How well do you speak English?

Very well
Well
Not well
Not at all

Sexual Orientation

Marital Status

Religion

Income/Economic Status

Do you have any additional communication needs? Tick as many as apply

Do you have any communication preference?

Do you have a disability or extra care needs?

Yes
No

Which types of vulnerability apply to you? Tick as many as apply

Physical mobility (For example, due to old age, or a physical condition such as amputation or arthritis)
Chronic illness (For example COPD, terminal illness)
Poor mental health (For example, long-term mental disorder, acute mental ill-health)
Learning difficulties, disabilities and conditions (For example, dyslexia, autism, Downs Syndrome)
Sensory impairment (For example, loss of sight, hearing, speech, or inability to communicate with others)

Do you require the use of an oxygen tank in your home?

Yes
No

In an emergency, would you able to self-evacuate? (high rise residents only)

Yes
No

Digital skills. Do you need assistance to access information and services digitally (such as the internet, online forms and email)?

Yes
No

Do you have an advocate?

Yes
No

If yes, enter advocate details here

Any other professional support in place?

Contact Details

Email

Main contact phone number

Alternate contact phone number

Third contact phone number

Additional People

Is there another main Tenant at this address?

Yes
No

Main Tenant 2

Title (Tenant 2)

First Name(s) (Tenant 2) *

Middle Name(s) (Tenant 2)

Surname (Tenant 2) *

Tenant 2 Relationship to main tenant *

Enter your relationship to the main tenant here (Tenant 2)

Date of Birth (Tenant 2) *

Sex (Tenant 2)

Male
Female
Non Binary

Gender Identity (Tenant 2)

Pronouns (Tenant 2)

He/Him
She/her
They/them
Other

Please enter your preferred pronouns here (Tenant 2)

Ethnicity (Tenant 2)

Nationality (Tenant 2)

British
Other

Add your nationality here (Tenant 2)

What is your main language? (Tenant 2)

English
Other

Add your main language here (Tenant 2)

How well do you speak English? (Tenant 2)

Very well
Well
Not well
Not at all

Sexual Orientation (Tenant 2)

Marital Status (Tenant 2)

Income/Economic Status (Tenant 2)

Religion (Tenant 2)

Do you have any additional communication needs? (Tenant 2) Tick as many as apply

Do you have any communication preference? (Tenant 2)

Do you have a disability or extra care needs? (Tenant 2)

Yes
No

Which types of vulnerability apply to you? Tick as many as apply (Tenant 2)

Physical mobility (For example, due to old age, or a physical condition such as amputation or arthritis)
Chronic illness (For example COPD, terminal illness)
Poor mental health (For example, long-term mental disorder, acute mental ill-health)
Learning difficulties, disabilities and conditions (For example, dyslexia, autism, Downs Syndrome)
Sensory impairment (For example, loss of sight, hearing, speech, or inability to communicate with others)

Do you require the use of an oxygen tank in your home? (Tenant 2)

Yes
No

In an emergency, would you be to self-evacuate (high rise residents only)? (Tenant 2)

Yes
No

Digital skills (Tenant 2). Do you need assistance to access information and services digitally (such as the internet, online forms and email)?

Yes
No

Do you have an advocate? (Tenant 2)

Yes
No

If yes, enter advocate details here (Tenant 2)

Any other professional support in place? (Tenant 2)

Contact Details (Tenant 2)

Email (Tenant 2)

Main contact phone number (Tenant 2)

Alternate contact phone number (Tenant 2)

Third contact phone number (Tenant 2)

Do any other people live at this address?

Yes
No

Person Number 2

Title (Person 2)

First Name (Person 2) *

Middle Name(s) (Person 2)

Surname(s) (Person 2) *

Person 2 Relationship to main tenant *

Enter your relationship to the main tenant here (Person 2)

Date of Birth (Person 2)

Sex (Person 2)

Male
Female
Non Binary

Gender Identity (Person 2)

Pronouns (Person 2)

He/Him
She/her
They/them
Other

Please enter their preferred pronouns here (Person 2)

Ethnicity (Person 2)

What is your nationality (Person 2)

British
Other

Add their nationality here (Person 2)

What is their main language? (Person 2)

English
Other

How well do they speak English? (Person 2)

Very well
Well
Not well
Not at all

Add their main language here (Person 2)

Sexual Orientation (Person 2)

Marital Status (Person 2)

Religion (Person 2)

Do they have a disability or extra care needs? (Person 2)?

Yes
No

Which types of vulnerability apply to them? Tick as many as apply (Person 2)

Physical mobility (For example, due to old age, or a physical condition such as amputation or arthritis)
Chronic illness (For example COPD, terminal illness)
Poor mental health (For example, long-term mental disorder, acute mental ill-health)
Learning difficulties, disabilities and conditions (For example, dyslexia, autism, Downs Syndrome)
Sensory impairment (For example, loss of sight, hearing, speech, or inability to communicate with others)

Do you require the use of an oxygen tank in your home? (Person 2)

Yes
No

In an emergency, would they be to self-evacuate (high rise residents only)? (Person 2)

Yes
No

Digital skills (Person 2). Do they need assistance to access information and services digitally (such as the internet, online forms and email)?

Yes
No

Is anyone else living at this address (Person 3)

Yes
No

Person Number 3

Title (Person 3)

First Name (Person 3) *

Middle Name(s) (Person 3)

Surname (Person 3) *

Person 3 Relationship to main tenant *

Enter your relationship to the main tenant here (Person 3)

Date of Birth (Person 3)

Sex (Tenant 3)

Male
Female
Non Binary

Gender Identity (Person 3)

Pronouns (Person 3)

He/Him
She/her
They/them
Other

Please enter their preferred pronouns here (Person 3)

Ethnicity (Person 3)

What is their nationality (Person 3)

British
Other

Add your nationality here (Person 3)

What is their main language? (Person 3)

English
Other

Add their main language here (Person 3)

How well do they speak English? (Person 3)

Very well
Well
Not well
Not at all

Sexual Orientation (Person 3)

Marital Status (Person 3)

Religion (Person 3)

Do they have a disability or extra care needs? (Person 3)?

Yes
No

Which types of vulnerability apply to them? Tick as many as apply (Person 3)

Physical mobility (For example, due to old age, or a physical condition such as amputation or arthritis)
Chronic illness (For example COPD, terminal illness)
Poor mental health (For example, long-term mental disorder, acute mental ill-health)
Learning difficulties, disabilities and conditions (For example, dyslexia, autism, Downs Syndrome)
Sensory impairment (For example, loss of sight, hearing, speech, or inability to communicate with others)

Do you require the use of an oxygen tank in your home? (Person 3)

Yes
No

In an emergency, would they be to self-evacuate (high rise residents only)? (Person 3)

Yes
No

Digital skills (Person 3). Do they need assistance to access information and services digitally (such as the internet, online forms and email)?

Yes
No

Is anyone else living at this address? (Person 4)

Yes
No

Person Number 4

Title (Person 4)

First Name (Person 4) *

Middle Name(s) (Person 4) (copy)

Surname (Person 4) *

Person 4 Relationship to main tenant *

Enter your relationship to the main tenant here (Person 4)

Date of Birth (Person 4)

Sex (Tenant 4)

Male
Female
Non Binary

Gender Identity (Person 4)

Pronouns (Person 4)

He/Him
She/her
They/them
Other

Please enter their preferred pronouns here (Person 4)

Ethnicity (Person 4)

What is their nationality (Person 4)

British
Other

Add your nationality here (Person 4)

What is their main language? (Person 4)

English
Other

Add their main language here (Person 4)

How well do they speak English? (Person 4)

Very well
Well
Not well
Not at all

Sexual Orientation (Person 4)

Marital Status (Person 4)

Religion (Person 4)

Do they have a disability or extra care needs? (Person 4)?

Yes
No

Which types of vulnerability apply to them? Tick as many as apply (Person 4)

Physical mobility (For example, due to old age, or a physical condition such as amputation or arthritis)
Chronic illness (For example COPD, terminal illness)
Poor mental health (For example, long-term mental disorder, acute mental ill-health)
Learning difficulties, disabilities and conditions (For example, dyslexia, autism, Downs Syndrome)
Sensory impairment (For example, loss of sight, hearing, speech, or inability to communicate with others)

Do you require the use of an oxygen tank in your home? (Person 4)

Yes
No

In an emergency, would they be to self-evacuate (high rise residents only)? (Person 4)

Yes
No

Digital skills (Person 4). Do they need assistance to access information and services digitally (such as the internet, online forms and email)?

Yes
No

Is anyone else living at this address? (Person 5)

Yes
No

Person Number 5

Title (Person 5)

First Name (Person 5) *

Middle Name(s) (Person 5)

Surname (Person 5) *

Relationship to main tenant (Tenant 5) *

Enter your relationship to the main tenant here (Person 5)

Date of Birth (Person 5)

Sex (Tenant 5)

Male
Female
Non Binary

Gender Identity (Person 5)

Pronouns (Person 5)

He/Him
She/her
They/them
Other

Please enter their preferred pronouns here (Person 5)

Ethnicity (Person 5)

What is their nationality (Person 5)

British
Other

Add your nationality here (Person 5)

What is their main language? (Person 5)

English
Other

Add their main language here (Person 5)

How well do they speak English? (Person 5)

Very well
Well
Not well
Not at all

Sexual Orientation (Person 5)

Marital Status (Person 5)

Religion (Person 5)

Do they have a disability or extra care needs? (Person 5)?

Yes
No

Which types of vulnerability apply to them? Tick as many as apply (Person 5)

Physical mobility (For example, due to old age, or a physical condition such as amputation or arthritis)
Chronic illness (For example COPD, terminal illness)
Poor mental health (For example, long-term mental disorder, acute mental ill-health)
Learning difficulties, disabilities and conditions (For example, dyslexia, autism, Downs Syndrome)
Sensory impairment (For example, loss of sight, hearing, speech, or inability to communicate with others)

Do you require the use of an oxygen tank in your home? (Person 5)

Yes
No

In an emergency, would they be to self-evacuate (high rise residents only)? (Person 5)

Yes
No

Digital skills (Person 5). Do they need assistance to access information and services digitally (such as the internet, online forms and email)?

Yes
No

Is anyone else living at this address? (Person 6)

Yes
No

Person Number 6

Title (Person 6)

First Name (Person 6) *

Middle Name(s)

Surname (Person 6) *

Relationship to main tenant (Tenant 6) *

Enter your relationship to the main tenant here (Person 6)

Date of Birth (Person 6)

Gender Identity (Person 6)

Pronouns (Person 6)

He/Him
She/her
They/them
Other

Please enter their preferred pronouns here (Person 6)

Ethnicity (Person 6)

What is their nationality (Person 6)

British
Other

Add your nationality here (Person 6)

What is their main language? (Person 6)

English
Other

Add their main language here (Person 6)

How well do they speak English? (Person 6)

Very well
Well
Not well
Not at all

Sexual Orientation (Person 6)

Marital Status (Person 6)

Religion (Person 6)

Do they have a disability or extra care needs? (Person 6)?

Yes
No

Which types of vulnerability apply to them? Tick as many as apply (Person 6)

Physical mobility (For example, due to old age, or a physical condition such as amputation or arthritis)
Chronic illness (For example COPD, terminal illness)
Poor mental health (For example, long-term mental disorder, acute mental ill-health)
Learning difficulties, disabilities and conditions (For example, dyslexia, autism, Downs Syndrome)
Sensory impairment (For example, loss of sight, hearing, speech, or inability to communicate with others)

Do you require the use of an oxygen tank in your home? (Person 6)

Yes
No

In an emergency, would they be to self-evacuate (high rise residents only)? (Person 6)

Yes
No

Digital skills (Person 6). Do they need assistance to access information and services digitally (such as the internet, online forms and email)?

Yes
No

Is anyone else living at this address? (Person 7)

Yes
No

Person Number 7

Title (Person 7)

First Name (Person 7) *

Middle Name(s) (Person 7)

Surname (Person 7) *

Relationship to main tenant (Tenant 7) *

Enter your relationship to the main tenant here (Person 7)

Date of Birth (Person 7)

Gender Identity (Person 7)

Pronouns (Person 7)

He/Him
She/her
They/them
Other

Please enter their preferred pronouns here (Person 6) (copy)

Ethnicity (Person 7)

What is their nationality (Person 7)

British
Other

Add your nationality here (Person 7)

What is their main language? (Person 7)

English
Other

Add their main language here (Person 7)

How well do they speak English? (Person 7)

Very well
Well
Not well
Not at all

Sexual Orientation (Person 7)

Marital Status (Person 7)

Religion (Person 7)

Do they have a disability or extra care needs? (Person 7)?

Yes
No

Which types of vulnerability apply to them? Tick as many as apply (Person 7)

Physical mobility (For example, due to old age, or a physical condition such as amputation or arthritis)
Chronic illness (For example COPD, terminal illness)
Poor mental health (For example, long-term mental disorder, acute mental ill-health)
Learning difficulties, disabilities and conditions (For example, dyslexia, autism, Downs Syndrome)
Sensory impairment (For example, loss of sight, hearing, speech, or inability to communicate with others)

Do you require the use of an oxygen tank in your home? (Person 7)

Yes
No

In an emergency, would they be to self-evacuate (high rise residents only)? (Person 7)

Yes
No

Digital skills (Person 7). Do they need assistance to access information and services digitally (such as the internet, online forms and email)?

Yes
No

Permissions

Do you consent to the processing of this information?

Yes
No

The information which you provide on this form will be used by Solihull Community Housing, for the purpose of tailoring and improving services offered to residents, as well as meeting legal and regulatory obligations. It may also be shared with Solihull Council, and partner organisations to ensure that our records are kept accurate and up to date and to help us identify other services which you may be entitled to.

Our full privacy notice can be found here: Data Protection - Solihull Community Housing

Main Tenant 1

Contact Details

Additional People

Main Tenant 2

Contact Details (Tenant 2)

Person Number 2

Person Number 3

Person Number 4

Person Number 5

Person Number 6

Person Number 7

Permissions

Contact Us

Social media

Quick Links

Accreditations

Everyone Matters

Main Tenant 1

Contact Details

Additional People

Main Tenant 2

Contact Details (Tenant 2)

Person Number 2

Person Number 3

Person Number 4

Person Number 5

Person Number 6

Person Number 7

Permissions

Contact Us

Social media

Quick Links

Accreditations

Cookies on the Solihull Community Housing website.