Application request
ONLY for completion by referring organisations. Please note change to request monthly instead of weekly incomes.
Applicant's name
*
Prefix
First Name
Last Name
Age
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number (Optional)
-
Area Code
Phone Number
Spouse /Partner's name
*
First Name
Last Name
Children's names & ages
*
Earnings per MONTH EXCLUDING benefits
*
Benefits received
*
Benefits total £ per MONTH
*
Outstanding debts.
*
Sponsoring organisation
*
Organisation Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Organiser's name
*
First Name
Last Name
Organiser's email
*
Organiser's Reference
Organiser's contact phone for any queries
*
-
Area Code
Phone Number
General background report on need -keep it short but give us enough!
*
Is there a background of domestic abuse?
Please Select
Yes
No
Prefer not to say
If you are applying for food, why aren't you using the food bank?
Please Note:
We are unable to help with: rent or mortgage payments, catalogue and credit card debts, loan or court costs and fines. ONLY ONE GRANT APPLICATION REQUEST PER 12 MONTHS
What is the grant intended to buy? How much money are you applying for?:
*
To whom should cheque(s) or BACS be made payable (this cannot be the grant applicant):
*
Have you considered whether the Cambridgeshire Local Assistance Scheme can make a grant? (see website link, especially for white goods)
*
Have you applied to any other Charities, and if so, which?
*
Applicant’s ethnicity?
*
Please Select
White.
Mixed or multiple ethnic groups.
Asian or Asian British.
Black or Black British (Caribbean or African or Other).
Other.
Prefer not to say.
Submit
Should be Empty: