JW Chapman Trust Application Form

Name* This field is required.

First Name

Middle Name

Last Name

E-mail* This field is required.

example@example.com

Gender* This field is required.

Male

Female

Transgender

Prefer not to say

Marital Status

Marital Status* This field is required.Please Select

Please Select

Single

Married

Civil Partnership

Divorced

Separated

Widowed

Date of Birth* This field is required.

National Insurance Number* This field is required.

Contact Number:* This field is required.If Mobile Put 0 in Area code

Area Code

Phone Number

Address:* This field is required.

Street Address

Street Address Line 2

Town/city

Post Code

Country

Child Information

First Name

Surname

Sex

Date of Birth

Child A

Child B

Child C

Child D

Child A

Child B

Child C

Child D

First Name

Surname

Sex

Date of Birth

First Name

Surname

Sex

Date of Birth

First Name

Surname

Sex

Date of Birth

First Name

Surname

Sex

Date of Birth

Child Medical ProblemsSet out any medical problems

Accommodation Type

Council Rented

Private Rental

Owned

Other

Number of Bedrooms

Number of Bedrooms* This field is required.

1 Bedroom

2 Bedrooms

3 Bedrooms

4 Bedrooms

5 Bedrooms

More than 5 Bedrooms

Number of Living/Reception Rooms

Total Number of Living / Reception Rooms* This field is required.

1 Living / Reception Room

2 Living / Reception Rooms

3 Living / Reception Rooms

More than 3 Living / Reception Rooms

Total Number of Persons Living in Property

Total Number of Persons Living in the Property* This field is required.Include Children [ If you live in a flat this is just the persons in your own flat ]

1 Person

2 Persons

3 Persons

4 Persons

5 Persons

6 Persons

7 Persons

8 Persons

More than 8 persons

Amount of Savings* This field is required.Type 0 if you have none

Weekly Income* This field is required.

Sources of Income Indicate Benefits and amounts

Partners Sources of IncomeIndicates benefits and amounts

Other Loans and Awards

Date

Amount

Outstanding

Award 1

Award 2

Award 3

Award 4

Award 5

Award 1

Award 2

Award 3

Award 4

Award 5

Date

Amount

Outstanding

Date

Amount

Outstanding

Date

Amount

Outstanding

Date

Amount

Outstanding

Date

Amount

Outstanding

For each Award set out what it was for and who provided it to you

Refused Loans and Awards

Date

Amount

Reason

APP 1

APP 2

APP 3

App 4

APP 5

APP 1

APP 2

APP 3

App 4

APP 5

Date

Amount

Reason

Date

Amount

Reason

Date

Amount

Reason

Date

Amount

Reason

Date

Amount

Reason

For each Refusal set out what it was for and who rejected your application

Pending ApplicationsDetails of any other current applications

What are you applying for ?* This field is required.Pick which type of application you are making

Beds

Carpets

Clothing Grant

Cooker

Fridge/Freezer

Washing Machine

Mattresses

Please set out why you are applying for these * This field is required.If you Ticked Other Item in the last question put in this box what other item you are applying for

Have you applied to the Trust before ? * This field is required.

YESNO

Have you applied to the trust before ?* This field is required.

Yes

Type option 3

Type option 4

Date of any previous application

Date

Complete your Declaration* This field is required.

Yes

Data Protection* This field is required.Under the GDPR we can only hold your data in certain circumstances . We will hold your Data during the process of your application and for 2 years afterwards for the purposes of checking multiple applications under our Charity Rules . We would like your consent to hold the data longer for the purpose of contacting you and also using the information to help the work of the trust . Please complete a specific consensus over this .

I consent to the Trust holding my Data and contacting me about my applications and in relation to trust activities

I do not consent to the Trust holding my Data and contacting me about my applications and in relation to trust activities

Do you need to send us a file in support of your application . Upload it here

Drag and drop files here

Select files to upload

Max. file size: 10.6MB

JW Chapman Trust Application Form