Furniture Bank Application

Application to Furniture Bank

We provide good quality used furniture to those in need, residing in the borough of Mid Suffolk District Council. Whilst we have no strict criteria, the household has to be in financial need and with no means to be able to fund the furniture themselves. If you would like to discuss your application please Carrie on 07827 440353.
Referrer's Details
Name

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

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Telephone Number
Number of Children

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 is needed (b) why this family requires support, and (c) what difference you think our funding will make to them.
What furniture is required? (Please note we only provide essential items - beds, mattresses, wardrobes, drawers, sofas, tables, chairs)
Our usual delivery days are Tuesday's and Wednesday's, we will confirm direct with client what date and approximate time to expect the delivery but please confirm who will be there to receive the furniture:
Are there any risk factors we should be aware of before we visit the home?
Signature

Clear
Date

MonthDayYear
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Application to Furniture Bank