Hardship Fund Application

Application to Hardship Fund
If you are working with a family or individual in financial need, living within Mid Suffolk District Council, please complete this form. For any queries around criteria or for problems completing the form please call The Forge office on 01449 710437 or Becky on 07725 434242. Applications are assessed and considered on a weekly basis.
Referrer's Details
Name

First NameLast Name
Email
example@example.com
Phone Number
Relationship with family
Other professionals working with family
Details of Family
Carer's Name

First NameLast Name
Phone Number
Address

Street Address

Street Address Line 2

CityCounty

Postal Code
Names of children and DOB/EDD

Does anyone in the household meet any of these criteria? (Please tick all that apply)

	YES	No
Eligible for free school meals
Bereavement
Child in care
Homelessness/overcrowded accommodation
Special educational needs
EAL/Traveler family
Lone parent
Teen parent
Workless household
Other (please state)

Reason for application
Please give a brief description including;(a) what funding you require and for what purpose (b) why this family requires support from this fund, and (c) what difference you think our funding will make to them.
What contributions are being made towards these costs and by whom? (ie. family, your organisations, other source)
How much are you applying for? (We cannot process the application if this is left blank)
If a grant is offered, what is the best method of payment?
If bank transfer, please state account number and sort code
Signature

Clear
Date

MonthDayYear
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Application to Hardship Fund