Download the form by clicking on the button opposite. The form can be printed and completed by hand or alternatively by typing into the PDF.
Guidance notes for completion of application forms
- Please complete EVERY section of the form clearly and with as many details as possible.
- If full financial details (for all members of the household) or other essential information are not completed, the application form WILL BE returned to the support worker.
- The application MUST BE endorsed with a supporting statement by a professional working to support the individual/family. The statement may be continued onto another sheet: it is important that the Trustees have as much information as possible to help them understand and consider the request for assistance. Please ensure the statement explains the individual/family circumstances and sets out the reason for the request and what impact the financial assistance will have on the individual/family concerned.
- When returning the form, YOU MUST attach quotes for the specific items requested. For electrical items we suggest you obtain quotes from Economy Cookers or Cooper & Elms. For carpets we have found that the Derwent range is a decent quality carpet at a reasonable price and applications for that range or similar will be considered. Please ensure that all carpet quotes state cost per square metre.
- When seeking financial assistance for more than one item, or for carpeting more than one room, please rank each item requested in priority order.
- On completion, the form, any additional information and quotations should be emailed to the Charity Secretary:
For further guidance, please see ‘Frequently Asked Questions’