Hardship Fund Application

Hardship Fund Application

Apply for financial assistance by providing your details below.
Name

First NameLast Name
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Email address
example@example.com
Phone number

Phone Number
Home address

Street Address

Street Address Line 2
City`CountyPostal code
Employment status
Monthly household income
Main source of income?
After your monthly bills have been paid, does your current account exceed £1,000?
Number of people and ages living at this address
Do you have any savings? Including Premium bonds / Shares /Land Owned/ Saving Certificates/ ISA’s)
If yes, please specify the total amount of savings
What assistance is required? Please give details - eg food vouchers, washing machine, school uniform, carpets etc
Please give a brief reason for the help needed
Has the applicant or any other adults living at the address applied for assistance from the Alconbury Weald Hardship Fund before?
If yes, please give details of when and assistance given
Have you applied for any other assistance/ grants for this issue?
If yes please supply details of the outcome
Name of contact or referring organisation? - eg Ermine Street Church Academy or Alconbury Surgery are one of many who can refer
All information provided on this application will be treated in the strictest confidence and stored securely in accordance with UK GDPR and data protection legislation. Personal information will only be accessed by those directly involved in processing your application, which is usually no more than two authorised members of the Hardship Fund team.

Where necessary to process your application or provide support, relevant information may be shared with trusted third parties, such as healthcare providers, delivery companies, local authorities, charities, or other voluntary organisations. Information will only be shared where it is necessary, proportionate, and in your best interests, or where we are required to do so by law.
I confirm that I have read and understood the Hardship Fund privacy notice and confirm the information I have provided is true and accurate. I understand providing misleading or false information may affect my application.
Signature
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