Food Bank Support Request

Food Bank Support

Please answer the following questions and we will do our best to get a care package available for your to collect as soon as possible.
YOU MUST ANSWER ALL QUESTIONS. Any false or misleading information may result in us refusing you support
Name*

First NameLast Name
Phone Number*

Area CodePhone Number
Email
example@example.com
Address*

Street Address

Street Address Line 2

CityCounty

Post Code
How many are you in your household?*
How many adults?*
How many of them are children?*
How many over 65's?*
Please list the details of your household below:*
Please list all members of your household, their relationship to you and their age. If you live alone, please put N/A*
What is your current employment status?*

Full TimePart TimeUnemployedRetired
If you are EMPLOYED or RETIRED, how much is your monthly income? (£, you MUST include all income, whether you are employed, self employed or retired and in receipt of either state pension, private pension or armed forces pension)*
Do you consider yourself as disabled?*

YesNo
If you answered Yes to the above question, please tell us about your disabilities?
Are you currently in receipt of any benefits? if so please specify what kind of benefit you receive and how much you receive each month;*
Is anyone else in your household employed? if so please tell us who and their monthly income;*
Is anyone else in your household in receipt of benefits? if so please tell us what kind of benefits and how much they receive;*
How much is the monthly rent? (£)*
Support we provide

The support we provide is designed to be short term for short difficult periods. It is not a solution to a bigger problem. While we aim to support as many families and individuals as possible. We will look at how many times you have requested support from us. We may ask you to speak to one of our advisors and look at other ways that we can support you or signpost you to any additional support. In order for us to help you, we expect that you will be honest about your circumstances and work with us.
Support from our food bank is designed to be short term and help you over a difficult period. If you are suffering financial hardship, please explain why you are seeking our support.;*
Failure to provide an answer may result in refusal to provide support
Have you requested assistance from any other food bank in the past MONTH?*
Do you or any member of your family have any special dietary requirements or allergies?*
If you answered yes, please tell us about any special dietary requirements or allergies;
Please tell us any specific items that you may need in your care package;*

No Special RequirementsHousehold Cleaning ProductsFemale ToiletriesMale ToiletriesToilet rollsCat FoodDog FoodBaby FoodNappies please specify size under 'Other'Other
Requests received before 5pm on Monday will be available to collect on a Wednesday.

Requests received after 5pm Monday and up to 5pm Wednesday will be available to collect on Friday from the Miners Lamp.
If you need a bit of additional support with household costs please contact Northumberland Communities Together and ask about the Household Support Fund.

Please call the Northumberland Communities Together team on: 01670 620 015 9am – 6pm (Mon – Friday) or email at: NCT@northumberland.gov.uk.Your application will be dealt with by this team who may need to contact you for further information to support your application.
Declaration

Our food bank is designed to support you through a short difficult period. Where you require support regularly over a longer period of time, we may ask you to talk with a member of our staff to review your current situation with the aim of providing any additional support.
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Food Bank Support

YOU MUST ANSWER ALL QUESTIONS. Any false or misleading information may result in us refusing you support

Support we provide

If you need a bit of additional support with household costs please contact Northumberland Communities Together and ask about the Household Support Fund.

Declaration