Essential Grants Programme Application Form Please enable JavaScript in your browser to complete this form.Reference allocated* to be completed by CCSP/office Referring Agency *Number of children in the family: *Ages of Children in Family: *Number of adults in the family: *Which of the following benefits do you receive?ESAJSAChild Tax CreditsHousing BenefitIncome SupportPIPCarer’s AllowanceCouncil Tax BenefitUniversal CreditEntitled, but not claimingOtherOther (please clarify)Are you working with other professional services? If so, please tell us who? *Do you think there may be benefits you might be eligible for but have not yet applied for? *What is the item (or items) you need for your family? If there are several items needed, please state which item is the priority and list in order of need: *Please tell us about your family circumstances and how a grant will help your family. Please tell us how your child(ren)’s life will be better for having this item/s. We require this information in the applicant’s words so that the panel can better understand the families’ current situation /need: *Item Specifics To be filled out if you have requested an item specified below.Electric Cooker (Not including Installation)Electric Cooker Inc. Installation (N.B Installation will only be granted if it is necessary-e.g., Hardwired Cooker)Please note funds cannot be transferred directly to a family, CCSP will purchase items and arrange delivery to the family home. [Hence, it is vital that contact details are correct]. In some cases, uniform can be arranged through a local store and appointments made for the family to attend. School Uniform/ClothingItem(s):Please include size, quantity and colour or house if necessary.Item(s):Please include size, quantity and colour or house if necessary.Item(s):Please include size, quantity and colour or house if necessary.Item(s):Please include size, quantity and colour or house if necessary. so, address: applied Item(s):Please include size, quantity and colour or house if necessary.Applicant/individual requiring the grant: *Home Address Line 1 *Home Address Line 2Post Town/City *County *Post Code *Applicants home address: *Telephone/mobile number: *Email address: *Application submitted by Professional Supporting Agency: *Name of referee *Telephone/contact number: *Email address: *Once the office has received your application it will be allocated a reference number. Please make a note of this and refer to it in any communication. Please be aware that incomplete applications or missing information will delay your application. [Most correspondence will be via the referee/supporting agency and CCSP] All information supplied on this form will be kept confidentially and in accordance with the General Data Protection Regulation (GDPR). However, in order to fulfil the orders and the deliveries of the items approved and granted to the applicant, we will share personal information with the necessary 3rd party retailers and/or couriers. In addition, the grant administrator will share your information internally, with The Board of Trustee Directors, in order that a decision regarding the outcome of the application may be made. We will only contact you for the purposes of this application unless you consent otherwise. Please see our Privacy policy on our website for further information.Submit
