Application Form

Watlington Support Fund (Registered Charity No. 241730)

WSF offers assistance to residents of the Parish of Watlington who are suffering financial hardship, sickness or disability. • The trustees can help by making grants of money or by providing or paying for goods, services or facilities. • In exceptional cases the trustees may assist someone who is resident immediately outside the Parish of Watlington or only temporarily resident. Your answers will be confidential. Please complete all the questions - we may not be able to proceed with your application if it is incomplete. Please note that we may request evidence and supporting documentation. We will also endeavour to arrange a visit with applicants before determining what help should be provided.
- Name
  
  First nameLast name
- Address
  
  Street Address
  
  Street Address Line 2
  
  TownCounty
  
  Post code
- Phone number
  Please provide the best phone number to contact you.
- Email
  example@example.com
- Please tell us your marital status:
- Please tell us about who lives in your household with you, and their age if they are under 18.
- What is your reason for contacting the Watlington Support Fund?
- How would you like the Watlington Support Fund to help you? How much money are you requesting?
- Please tell us about the property you live in. I am:
- Other - Please provide more information:
- Housing Association / Local Authority
- Please give your employment details over the last 2 years (with whom and when):
- What is your monthly income? Please include ALL income including wages / salary / pensions, benefits (working tax, child, housing, council tax, employment support allowance etc). Please list each source of income on a separate row.
- Total monthly income:
- What is your monthly expenditure? Please include ALL expenditure including housing costs, council tax, food costs, household expenses, utility bills, credit card/loan payments, tv, internet, mobile phone, and any other regular payments. Please list each item on a separate row.
- Total monthly expenditure:
- What is the value of all your savings excluding the value of the home you live in?
- Please tell us about any money you owe. Please tell us who you owe the money to, and what any outstanding balances are.
- Please complete this section if your application is related to sickness or disability. What is the nature of your sickness or disability.
- Is your application supported by a medical professional?
- If 'yes', please give their details below.
- Do you authorise the charity to discuss your application with this person?
- The Trustees may wish to meet with you to discuss your application. Please let us know when would be convenient.
- Please use this section to provide us with any other information to support your application.
- How did you hear about Watlington Support Fund
- Have you applied to any other organisations for grants for this purpose?
- Do you authorise the Charity to disclose your application to and discuss it with other relevant people e.g. Housing Association, loan companies, utility companies, Citizen’s Advice, your family, a particular friend?
- If ‘Yes’ please specify who you authorise us to speak to:
- Please provide us with any documents to support your application.
  
  Cancelof
- I declare that the information I have given above is true and complete to the best of my knowledge. Please sign below.
- DATA PROTECTION
  By submitting this application you agree to the information contained being shared with the trustees and any employees of Watlington Support Fund. It will be dealt with in confidence. We will not share it with any other person or body without your permission.
- Should be Empty:

Watlington Support Fund (Registered Charity No. 241730)