application form - aberdeenshire · the scottish welfare fund – application form 9 about money...

1 THE SCOTTISH WELFARE FUND – APPLICATION FORM

APPLICATION FORM

ABOUT CRISIS GRANTS AND COMMUNITY CARE GRANTS

Who can get a Crisis Grant or a Community Care Grant?

You may be able to get a Crisis Grant or Community Care Grant if you are getting one of these benefits:

• IncomeSupport

• incomebasedJobseeker’sAllowance

• incomerelatedEmploymentandSupportAllowance

• anytypeofPensionCredit.

YoumayalsobeabletogetaCommunityCareGrantifyouarelikelytogetoneofthesebenefitswhenyouleavecare,suchasahospital,acarehomeoraprison.Ifyouarenotononeofthesebenefits,buthavenowheretoturninacrisis,theCouncilmaydecidetomakeanexceptionandawardyouaCrisisGrant,butthiswouldbeunusual.ACommunityCareGrantoraCrisisGrantmaybegoodsoritems,vouchersorcash.

How we decide whether we will give you a grant

Adecisionmakerwilllookatalltheinformationonyourapplicationbeforedecidingifwecanmakeagrant.Thereisonlyalimitedamountofmoneyavailableforpaymentsanditemssowecannotmakeagrantineverycase.

Theinformationyougiveusontheformwillhelpusdecide:

• ifyouqualifyforapaymentoritems,andifso

• whetherwecanmakeagrantfromthemoneywehaveinthebudgetandwhattheawardshouldbe.

Youneedtogiveusasmuchinformationasyoucanabouthowagrantwouldhelpyou,eithertocopewithacrisisortoliveindependentlyinthecommunity.Wewillusethisinformationtodecidewhetherornotwecangiveyouagrant.Ifyoudonotgiveustheinformationweaskforintheform,wewillnotbeabletogiveyouagrant.Wewillchecksomeoftheinformationyougiveus,forexamplethebenefitsyouareon,withDWP.Wemayalsotalktootherpeopleaboutyourapplication,forexamplesocialworkersordoctors.Wewillonlymakeagrantorgiveyouitemsifwearesurethatthisistheonlywaythatyoucangetthehelpyouneed.Wemayalsodecidetogiveyoulessthanyouhaveaskedfor.


How a Crisis Grant can help

ACrisisGrantistohelpsomeonepayforthethingstheyneedtopreventharmtotheirortheirfamily’shealthorsafetybecauseofanemergencyordisaster.

What you should not apply for:

YoushouldnotapplyforaCrisisGrantifyouhave:

• othermoneythatyoucanuseforthethingsyouneed

• alreadyhadthreeCrisisGrantsorawardsmadetoyouinthelast12months.ThisdoesnotincludeSocialFundapplicationsbeforeApril2013

•appliedforaCrisisGrantforthesamethingswithinthelast28daysandnothinghaschanged.

How a Community Care Grant can help

ACommunityCareGrantistohelpapersonwiththingstheyneedtoliveindependentlyinthecommunityratherthanhavingtoliveincare.Thiscouldbebecausetheyare:

• settingupinthecommunityafteraperiodincare

• wanttostayinthecommunityratherthanhavingtogointocare

• takingpartinaplannedre-settlementprogrammeafteranunsettledwayoflife

• afamilyfacingexceptionalpressure,forexamplebecauseoffamilybreakdown,andneedhelptoprovideasafeandsecureenvironmentfortheirchildren

• caringforaprisoneroryoungoffenderonreleaseontemporarylicence.

CrisisGrantsandCommunityCareGrantsdonothavetobepaidback.

What you should not apply for:

YoushouldnotapplyforaCommunityCareGrantifyou:

• havesavingsof£700ormoreandyouareunderpensionage,orsavingsof£1200ormoreandyouareoverpensionage.YourapplicationforaCommunityCareGrantwillnotbesuccessfulunlessthereisareasonwhyyoucannotusethesesavings

• areincare,arenotleavingcarewithin8weeksorhavenotbeenincarefor 3monthsormore

• haveappliedforaCommunityCareGrantforthesamethingswithinthelast 28daysandnothinghaschanged.

Help from other sourcesTheDWPisstillprovidingBudgetingLoansormaybeabletogiveyouashort-termAdvanceonBenefit.Ifyoudon’tthinkyouwouldgetaCrisisorCommunityCareGrantorbenefitsfromtheDWPbutstillneedhelp,aCitizensAdviceBureau,yourCounciloralocalwelfarerightsorganisationmayalsobeabletoofferyouadvice.YoucanfindyourlocalCitizensAdviceBureauinthephonebookoratthiswebsite: www.cas.org.uk/bureaux. YoucanfindoutmoreaboutlocalwelfarerightsorganisationsontheRightsAdviceScotlandwebsiteatwww.rascot.co.uk.

THE SCOTTISH WELFARE FUND – APPLICATION FORM 3

FILLING IN THE FORMWhat you will need to fill in this form:• yourNationalInsurancenumber• detailsofmoneyyoureceive• contactdetailsforpeoplewhoarehelpingyouwhotheCouncilmaywanttocontact• informationtoprovethatyouarewhoyousayyouare,and

• otherdocumentsthatgiveinformationaboutyoursituation,suchasthepoliceincidentnumberifyouhavereportedacrime.

If you need help to fill in the form

Thisformshouldbefilledinbythepersonmakingtheapplication.Ifyouneedhelptofillinthisform,youcanasksomeoneelsesuchasafriendorrelative,oryoucancontactyourlocalCouncilorCitizensAdviceBureau.YoustillneedtosignthedeclarationatPart6yourself.

Applying on behalf of someone else

Ifyouareapplyingonbehalfofsomeoneelsewhoisunabletofillintheform,youshouldcompletetherelevantpartofsection6andaskthemtosignthesectionwhichauthorisesyoutoapplyontheirbehalf.Wewillthendealwithyouinfuture.Youshouldcompletetheformwiththedetailsofthepersonyouareactingfor.

About the form:

Thisformisinsixsections:

Part1. Generalinformationaboutyouandyourfamily

Part2.Aboutmoneyyouhaveandreceive

Part3.Whattypeofgrantyouareapplyingforandwhy

3a–CrisisGrantinaDisaster

3b–CrisisGrantinanEmergency

3c–CommunityCareGrant

Part4.Otherinformationthatwillhelpustomakeadecision

Part5. Aboutothersupportyoureceiveormightwanttoreceive

Part6. Declarationandwhathappensnext

YoushouldfillinParts1,2,4,5and6.YoushouldalsocompletethesectionofPart3whichisaboutthegrantyouareapplyingfor.Pleasecompletetheforminblackink. Ifyouneedextraspace,pleaseusetheblankpageatthebeginningofthisform.

Receipts

IfyouareawardedaCrisisGrantorCommunityCareGrantyoumaybeaskedtoprovidereceiptstoshowyouhaveboughttheitemsyourgrantwasawardedfor.Pleasemakesureyoukeepyourreceipts.

Review

Ifyoudonotagreewiththedecisionmadeonyourapplication,youcanaskforareview.Detailsofwhotocontactareattheendofthisform.


BLANk PAGE/ADDITIONAL SPACE


APPLICATION QUESTIONS

Part 1. General information about you and your family. Please give us some information about you, your partner if you have one, and the other people who live in your house with you.

You Your partner

Title

Surname

Othersurnamesyouhaveused

Allothernames

Yourcurrentaddress

Ifyouhavebeenatthisaddressforlessthan3months,pleasegiveyourpreviousaddress

NationalInsurancenumber

Dateofbirth

Sex Male Female Male Female

Adaytimephonenumbersothatwecancontactyouifweneedmoreinformation

Maincontactnumber Maincontactnumber

Othercontactnumber Othercontactnumber

Emailaddress

Whatisthebestwaytocontactyou?


About your home.

Whatsortofplacedoyoulivein?Pleasetickonefromthislist:

RentfromtheCouncil

Rentfromaprivatelandlord

Rentfromahousingassociation

Ahostel

Bedandbreakfast

Caravanormobilehome

Aresidential/carehome

Aresidentialschoolorchildren’saccommodation

Supportedaccommodation,forexampleshelteredhousingorhousingwithsupportafterbeing homeless

Livingwithfriends/relatives

Livingwithownparents

Ownyourhomeorjointlyownyourhome,includingwithamortgage

ArmedForcesaccommodation

Ahospital

Prisonoryoungoffender’sinstitution

Other

Ifother,pleasegivedetails:

Howlonghaveyoulivedhere?

Ifyourhomeisrented,pleasetellusaboutthelandlord.

Landlord’sname:

Landlord’sphonenumber:

Ifyouareinaprisonoryoungoffender’sinstitution,pleasegiveyourprisonernumber:

Whatisthenameoftheinstitutionyouarein?


About other people who live with you.

Pleasetellusaboutallthepeoplewholivewithyou,includingchildrenthatyousupport.Achildis16orunderoraged17-19andstillinfull-timeeducationorincludedontheirparent’sbenefitclaim.Thisincludesbabieswhohavenotyetbeenbornso,ifsomeoneispregnant,pleaseincludedetailsofthebaby.

Name/s Dateofbirth/duedate

Relationshiptoyou PleasetickthisboxifyoureceiveChildBenefitforthisperson

Pleasecontinueontheblankpageatthebeginningofthisformifyouneedmorespace.

PleasetellusaboutanyapplicationsyouhavemadeforCrisisorCommunityCareGrantsinthelast12months,includingwhenyouwerelivinginanotherCouncilarea.

Wasagrantgiven?Yes No

Haveyourcircumstanceschangedsincethelastapplication?Yes No

Ifyes,pleasetellushow:


Part 2. About money you have and receive.

In order to get a Crisis Grant or Community Care Grant, you need to be on certain benefits. Are you or your partner receiving any of the following welfare benefits? Please tick all of the benefits you and your partner are getting or will be getting:

You Your partner

IncomeSupport

PensionCredit

HousingBenefit

CouncilTaxReduction

Jobseeker’sAllowance(contribution-based)

Jobseeker’sAllowance(incomebased)

EmploymentandSupportAllowance(contribution-based)

EmploymentandSupportAllowance(incomerelated)

IncapacityBenefit

DisabilityLivingAllowance

PersonalIndependencePayment

WorkingTaxCredit

ChildTaxCredit

ChildBenefit

UniversalCredit

CarersAllowance

PensionCreditPlus

AreyouoryourpartnerwaitingtohearfromDWPaboutaclaimorappealforanywelfarebenefits?

Yes No Yes No

Pleasetellusaboutthis,forexamplewhatyouappliedforandwhenandwhoisdealingwithyourapplication:


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About money you or your partner get regularly (continued).

Haveyouoryourpartnerreceivedanymoneyrecentlyapartfromyourregularincome?Forexamplefinalwages,holidaypayorredundancypay?Yes No

You Your partner

Whatmoneydidyouoryourpartnerreceive?Pleasegivedetails:

Wheredidthemoneycomefrom?

Howmuchdidyouoryourpartnerget?

Whendidyouoryourpartnergetit?

Isthereanymoredue? Yes No Yes No

Howmuchandwhen?

AreyousubjecttoanysanctionordisallowancerelatingtoDWPbenefits?

Thismeansthatyourbenefithasbeenreducedorstoppedeventhough youarestillentitledtoit,becauseofsomethingyouhavedone.

Yes No

Ifso,pleasetellusaboutthis.Forexample,thereasonforthesanction,whenitstartedandwhenitwillfinish.WewillnotgiveaCrisisGrantforlivingexpenses ifyouaresubjecttoaDWPsanctionunlessyouareapplyingforfoodforchildren.WemaybeabletogiveyouaCrisisGrantifyouhaveexperiencedadisaster.


About savings and other money you could use. Please tell us about any money, savings, assets or capital that you have. This includes cash, money in a bank, building society or credit union. It might also be National Savings, Premium Bonds, stocks and shares, trust funds or endowment policies. We will not give you a grant if we think you have money that you could use, but some types of money can be ignored when we look at your application, for example business assets, rights in pension schemes, funeral plans and compensation for late payments of benefits.

You Your partner

Doyouoryourpartnerhaveanyothermoneyorsavingslistedabove?

Yes No Yes No

Ifso,howmuch?

Pleasesaywherethemoneyisheld,forexampleinabankaccountorbuildingsocietyorcreditunion.

Canyougettothismoneytouseit? Yes No Yes No

IfNo,whynot?

Isthereanyothermoneyyouoryourpartnercoulduse,e.g.acreditcard,authorisedoverdraft?

Yes No Yes No

Pleasetellusaboutthis:

Doyouoryourpartnerownahouseorpropertyapartfromwhereyoulive?

Yes No Yes No


Canyouoryourpartnergethelpfromanywhereelse,incashorinkind,forexamplefromfriendsandrelatives,charitiesorbenevolentfunds(thismightincludeborrowingitems)?

Yes No Yes No

Whathaveyouoryourpartnertried?


Part 3. What type of grant you are applying for and why. Please fill in the section which best fits your situation.

AreyouapplyingforaCrisisGrantbecauseofadisaster?Adisasterisasuddenmisfortunewhichusuallycausesdamageordestructiontopropertyand/orpossessions,forexampleafloodorafire

Yes No

IfYes,pleasefillinSection3atoapplyforaCrisisGrantinaDisaster

AreyouapplyingforaCrisisGrantbecauseofanemergency?Anemergencyisasudden,urgent,unexpectedeventwhichusuallyneedsimmediateaction,forexampleifyouhavelostallofyourmoney

Yes No

IfYes,pleasefillinSection3btoapplyforaCrisisGrantinanEmergency

AreyouapplyingforaCommunityCareGranttohelpyouliveinthecommunityratherthangoingintocareorstayingincare?

Yes No

IfYes,fromthelistbelow,tickthereasonwhyyouareapplyingandpleasefillinSection3ctoapplyforaCommunityCareGrant.

• Youneedhelpsettinguphomeinthecommunityafterbeingincare

• Youneedhelptostayinthecommunityratherthangoingintocare

• Youneedhelptosetuphomeinthecommunityaspartofaplanned re-settlementprogrammewithanorganisationhelpingyou

• Youneedhelptoprovideasafeandsecureenvironmentforyourchild/ childrenbecauseofexceptionalpressureonyourfamily,forexample becausethefamilyhasbrokendown

• Youneedhelptocareforaprisoneroryoungoffenderonreleaseor temporarylicence

3a. Crisis Grant in a Disaster. Please fill in this section if you have suffered from a disaster which may cause serious damage or risk to your or your family’s health or safety. You can apply for living expenses and for essential items for your home which you need as a result of the disaster.

Pleasetickthesortofdisasterthathasaffectedyou:

fire

majorflood

gasorotherexplosion

anothertypeofdisaster

Ifitisanothertypeofdisaster,pleasesaywhatitis:

Whathappened?


Whendidithappen?

Didanyemergencyservicesattend? Yes No

Whatwasdamaged?

Doyouhavehouseholdinsurance? Yes No

IfYes,areyouplanningto,orhaveyou,madeaclaim? Yes No

Whatmoneydidtheinsurancecompanygiveyouandhowmuchisleft?

Howhasthedisasteraffectedyouandyourfamily?

Ifmoneyhasbeenspent,saywhaton:

WecanonlymakeaCrisisGrantforlivingexpensesifthereisaseriousriskordangertoyouroryourfamily’shealthandsafety.Pleasetelluswhatthisrisk ordangeris:


Please tell us about the things that you are applying for, how many you need; this may include costs for daily living, such as food or electricity. As you are applying because of a disaster, you can also apply for household items which have been damaged, for example a cooker.

Whatdoyouneed? Howmanyorhowmuchdoyouneed?

Howmuchdoyouthinkitwillcost?

Whowilluseit?

For example: A cooker

1 £x plus £x delivery and £x installation

Me and my partner to cook for the family

3b. Crisis Grant in an Emergency. Please fill in this section if you are applying for a Crisis Grant because of an emergency which may cause serious damage or risk to you or your family’s health or safety. If you are applying because of an emergency, you can only apply for living expenses such as food or travel, not for items for your home.

Pleasesaywhattheemergencyis:

Whathappened:

Ifmoneyhasbeenlost,pleasesayhowmuchismissing £

Ifmoneyhasbeenstolen,pleasesayhowmuchismissing £

Haveyoureportedthelosstothepolice? Yes No

Pleasegivetheincidentnumber:


Pleasesayhowmuchfoodyouhaveleftandhowlongthiswilllast:

Doyoupayforyourgasorelectricitywithapre-paymentmeter? Yes No

Howmuchcreditisleftonthemeter? £

Howlongwillitlast?

WecanonlymakeaCrisisGrantforlivingexpensesifthereisaseriousrisktoyouoryourfamily’shealthandsafety.Pleasetelluswhatthisriskis:

Please tell us about the living costs that you are applying for and how much you need. This may include items such as electricity or travel expenses. If you need food, please say how many days you need it for. You cannot apply for household items if you are applying for a grant because of an emergency. Please use a new line for each new thing.



Whowilluseit?

For example: food until next benefit payment

x days £x Me, my partner and two children

PleasegotoSection4withotherinformation,unlessyouarealsoapplyingforaCommunityCareGrant.


3c. Community Care Grant – to help you live in the community rather than being in care. This includes: • settingupinthecommunityafteraperiodincare• wantingtostayinthecommunityratherthanhavingtogointocare• takingpartinaplannedre-settlementprogrammeafteranunsettledwayoflife• afamilyfacingexceptionalpressure,forexamplebecauseoffamilybreakdown,

andneedhelptoprovideasafeandsecureenvironmentforchildren• caringforaprisoneroryoungoffenderonreleaseontemporarylicence.

Areyouplanningtomove?Ifnot,goto–Yourcircumstances

Yes No

IfYes,pleasetellustheaddressyouaremovingto:

Ifyouaremoving,pleasetickthesortofhomeyouareplanningtomoveto:

Ahomeyouown

Rented–unfurnished

Rented–partlyfurnished

Rented–fullyfurnished

Other

Ifyouhavetickedother,pleasetellusaboutthis:

Ifthepropertyisrentedpleasetellusaboutthelandlord:

Landlord’sname:

Landlord’sphonenumber:


Your circumstances

Pleasetelluswhyyouneedhelptosetuporstayinthecommunity:

Areyoufollowingaprogrammeofsupporttohelpyoure-settleinthecommunityafteranunsettledwayoflife?Yes No

Whyareyoufollowingtheprogramme,forexampleisitbecauseyouhavehadproblemswithaddictions,orareyoufollowingaprogrammeofsupport,forexample,becauseyouhavebeenincareorbeenhomeless?

Whatdoestheprogrammeofsupportinvolve?

Please fill in this section if you need help to provide a safe and secure environment for your child or children because you are facing exceptional pressure and do not have the resources to meet these costs.

Whatistheexceptionalpressurethatyouoryourfamilyareunder?


Whatistheimpactonyourchild/children?

Please fill in this section if you need help caring for a prisoner or young offender on release on temporary licence.

Name:

Dateofbirth:

Theirrelationshiptoyou:

Nameofinstitution:

Theirprisonernumber:

Whatdatedoestheleavestart?

Whatdatedoestheleavefinish?

Tell us about the things that you are applying for. This may include items such as a bed, bedding, clothes or items for the kitchen such as a cooker. It may also include services such as removals or travel costs. If you are given a grant, you may be asked to provide receipts to show that you have bought the items the grant was awarded for. Please make sure you keep receipts.

Pleasetellusasmuchasyoucanabouthowthesethingswillhelpyou.

• Ifyouneedtoreplacesomething,telluswhatiswrongwiththeoneyouhaveandwhyyouneedtoreplaceit.

• Ifyouneedsomethingforthefirsttime,telluswhyyouneedit.Pleasetellusexactlywhatyouneed,forexample,ifyouneedclothing,whattypeofclothingyouneed.

• Forthingslikecurtainsandcarpets,tellusthesizesofthewindoworroomtheyarefor.

• Ifyouneedsomethingwithspecialfeaturesoradaptations,telluswhatthesefeaturesareandwhyyouneedthem.Ifyouneedmorespacetotellusaboutwhatyouneed,pleasecontinueontheblankpageatthebeginningofthisform.




Whowilluseit?

For example: A new winter jacket because I have put on weight while I was in care and the old one doesn’t fit any more

1 £x Me

Please tell us about any organisation that is helping you either to set up in the community or to stay in the community.

Pleasegivethenameoftheorganisationhelpingyou:

Pleasegivethenameofthepersonhelpingyou:

Pleasegivethephonenumberofthepersonhelpingyou:

Howaretheyhelpingyou?


Part 4. Other information that will help us to make a decision.

When we decide whether or not to give a grant, we look at how much difference a grant will make to the person applying or the person they care for. This means that we need to know about any problems, difficulties or special circumstances for you or the people you live with. We also need to know about changes in your circumstances. Please answer the questions below, telling us about things that are affecting you, how they have affected you and what help or treatment you have had. Please also tell us if you have had to spend extra money because of these problems.

Whatwillhappenifyoudonotgetagrant?

Pleasetellusifyouorsomeonenamedintheapplicationhashealthproblemssuchaschronicorterminalillness,disabilityforexampledeafnessorblindnessoranymedicalcondition:

Pleasetellusifyouorsomeonenamedintheapplicationhasmentalhealthproblems:


Isthereanyreasonwhyyouwouldneedaspecialtypeoftheitemthatyouhaveaskedfor,forexampledoyouneedanadaptationtothethingsyouhaveaskedforbecauseofadisability? Yes No


Pleasetellusifyouorsomeonenamedintheapplicationhaslearningdifficultiesorphysicalimpairments:

Pleasetellusifyouorsomeonenamedintheapplicationhasproblemswithaddictionsorsubstancemisuse:

Pleasetellusifyouorsomeonenamedintheapplicationhasproblemsbecauseofage,forexampledifficultyingettingaroundorneedinghelplookingafterthemselves:


Pleasetellusifyouorsomeonenamedintheapplicationhasbeenrecentlyhomelessandhowthishappened.Pleasegivethedates:

Pleasetellusifyouorsomeonenamedintheapplicationhashadasignificantchangesincircumstances,forexampleredundancy,evictionorrepossessionorleavingtheArmedForces:

Other Information –Pleaseusethisspacetotellusaboutanythingelseyouthinkweneedtoknowaboutthatyouhavenotalreadymentionedintheform.Thesemaybethingslikefamilyproblems,poorlivingconditionsorcopingafteradisaster.Tellusaboutanythingthatmakesyoursituationunusuallyhardtocopewithandwhy:


Part 5. About other support you receive or might want to receive.

Wemayknowaboutotherservicesthatyouwouldfinduseful.Pleaseletusknowaboutservicesthatyouarealreadyusing.

Didsomeonehelpyoutofillinthisform,forexampleafriendorfamilymemberoranadviceworker?

Yes No

Areyouoryourpartnerincontactwithotherservices,forexamplesocialwork,housing,welfarerights,healthcareorothers?

Yes No

Pleasetelluswhyyouareintouchwiththisserviceorservices:

Organisation/Department Nameofperson Phonenumber

Wouldyoulikeanadviceworkertocheckthatyouaregettingallofthebenefitsthatyouareentitledto?

Yes No

Doyoufinditdifficulttopayyourdebts?Wouldyoubeinterestedinspeakingtoadebtadviser?

Yes No

Doyouthinkyouwouldfindsomeadviceonmoneymanagementhelpful?

Yes No

IfyouhaveansweredYestothequestionsabove,wemaygiveyourdetailstosomeonewhocoulddothisforyou,dependingonhowmanypeopleareinterestedintheseservices.ThismaybesomeonefromtheCouncilorfromavoluntaryorganisation.Wouldyoubehappytobecontactedabouttheseservices?

Yes No


Part 6. Declaration and what happens next.

Ifwedecidetomakeagrant,wemaypayyouagrantorgiveyouvouchersortheitemsyouneed.Ifwearegoingtogiveyouitemsorvouchers,wewillcontactyoutoarrangefordeliveryorcollection.

About the account you want to use Ifwearegoingtopaycash,wemayneedtoknowyourbankaccountdetails.ItisveryimportantyoucompleteALLboxescorrectlyincludingthebuildingsocietyrollorreferencenumberifyouhaveone.

Ifyoutellusthewrongaccountdetailsyourpaymentmaybedelayedoryoumaylosemoney.Youcanfindtheaccountdetailsonyourbankdebitcardorbankstatements.Ifyouarenotsureaboutthedetails,askthebank,buildingsocietyorotheraccountprovider.Youcanuseanaccountinyournameorajointaccount.

Ifyoudonothaveanaccount,andarenotplanningtoopenone,pleaseticktheboxandwewillcontactyoutodiscussthebestwaytomakeapayment.

Ifyouareanappointeeoralegalrepresentativeactingonbehalfoftheapplicant,theaccountshouldbeinyournameonly.Tobepaidintoacreditunionaccountyoumustprovidethecreditunionaccountdetails.Yourcreditunionwillbeabletohelpyouwiththis.

Account details

Nameofaccountholder:

Fullnameofbank,buildingsocietyorotheraccountprovider:

Sortcode

Accountnumber

Buildingsocietyrollorreferencenumber

Ifyoudonothaveanaccountanddon’tintendtoopenonetickhere


Declaration

Pleasereadthedeclarationcarefullyandmakesureyouunderstanditbeforesigninganddatingtheform.Wecannotmakeadecisionaboutyourapplicationunlessyouhavesignedtheform.Evenifsomeonehasfilledintheformforyou, youmustsignitifyoucan.Makesurethatyouunderstandwhattheyhavewrittenbeforeyousignthedeclaration.Itisanoffencetogivefalseinformation.

Tick one of the following:

This is my application for a Crisis Grant Community Care Grant

• Ihavereadandunderstoodtheguidancenotesthatcomewiththisform.• Iunderstandthat:

–theCouncilwillusetheinformationIhavegiventodecidewhethertoawardmea grant;

–theCouncilwillchecktheinformationIhavegivenwiththeorganisationsIhavenamedontheformandmakeanyotherenquiriestocheckthattheinformationIhavegiveniscorrect;

–theCouncilwillusetheinformationandshareitwithotheragencies,includingtheScottishGovernment,forresearchandanalysistomonitorthisserviceandprovidebetterservices;

–theCouncilwillkeepacopyofthisapplicationinaccordancewithitsretentionpolicy.• Ialsounderstandthat:

–theCouncilmaydecidetomakeagrantforsupervisedspendbytheCouncilorby another organisation;

–theCouncilmayrequiremetoprovidereceiptsforthethingsIbuy,sothatImustkeepmyreceipts.

• Ideclarethat,ifIamawardedagrant,IwillspenditonthethingsIhaveaskedfor.• IalsodeclarethattheinformationIhavegivenonthisformiscorrectand

completeasfarasIknowandbelieve.

Signature:

Date:

Printyourname:

If this form has been filled in by someone different from the person claiming.Ifyouaresigningthisformforsomeoneelsewhocannotapplyforthemselves,pleasecompletethissection.Youdonotneedtocompletethissectionifyouhavehelpedsomeonefillintheformbuttheyaresigningit.

Pleaseprintthenameofthepersonwhocompletedtheform:

Contactaddress:

Telephonenumber:


Emailaddress:

Whatisyourrelationshiptotheapplicant?

Pleasegivethereasonwhytheapplicantwasunabletocompletetheform:

Pleaseasktheapplicanttosignthissectiontogiveyoutheauthoritytoapplyontheirbehalf.

IherebyauthorisethepersonnamedabovetoapplyforaCrisisGrantorCommunityCareGrantonmybehalf.Iwouldlikethemtoreceiveallcorrespondenceabouttheclaim.

Signed

Youshouldcompletetherestoftheformwiththedetailsofthepersonyouarefillingintheapplicationfor.Wewillsendallcorrespondencetoyou.

What to do now

• Checkyouhaveansweredallthequestionsandgivenallinformationrequested

• Initialanyalterations

• Checkyouhavesignedtheform

• SendortakeyourformtotheCouncilyouareapplyingto.YoucanfindCouncilcontactdetailsontheScottishGovernment’sScottishWelfareFundwebsite.

Processing times

IfyourapplicationisforaCrisisGrant,wewillprocessitassoonaspossible. Weaimforallapplicationstobeprocessedin2workingdays.WeaimtoprocessCommunityCareGrantapplicationswithin15workingdays.

Youwillreceivealettertotellyouwhetherornotyouwillreceiveagrant.Ifyourapplicationisurgent,wewillalsocontactyoubyphonetoletyouknow.

What to do if you disagree with our decision: Ifyouarenothappywiththedecisiononyourapplicationyoucanaskustolookatitagain.TheCrisisGrantandCommunityCareGrantsectionattheCouncilwilllookatyourapplicationagaintocheckwhethertheyhavemadetherightdecision.Youmustwritetouswithin20workingdaysofthedecisionandtelluswhyyouwantareview.


Helping us to improve our service

TheScottishWelfareFundisanewfund.Wewanttounderstandhowwellitisworkingsothatwecanimproveitinthefuture.Wewouldlikeyoutoanswerthesequestionstohelpusbuttheyarenotpartofyourapplicationsoyoudonothaveto.Ifyoudoanswerthem,wewillnotusetheanswerstoanyofthesequestionstodecidewhetherornottogiveyouagrant.

Wouldyoubewillingtoanswersomequestionsaboutyourexperienceofusingthefund?IfyouanswerYes,wemaypassonyourcontactdetailstoapprovedresearcherstocontactyoudirecttoaskyousomequestions.

Yes No

WewanttounderstandwhoisapplyingtotheScottishWelfareFundsothatwecanmakesurethatparticulargroupsarenotdisadvantaged.Itwouldbehelpfulifyoucouldticktheboxesbelowthatmostcloselyfityou:

Whatreligion,religiousdenominationorbodydoyoubelongto?

None Buddhist OtherChristian Pagan

ChurchofScotland Sikh Hindu

RomanCatholic Jewish Muslim

Anotherreligion,pleasewritein

Whatisyourethnicgroup?

WhiteScottish

OtherBritish

Irish

Gypsy/Traveller

Polish

Otherwhiteethnicgroup

Mixedormultipleethnicgroup

Pakistani,PakistaniScottishor PakistaniBritish

Indian,IndianScottishor IndianBritish

Bangladeshi,BangladeshiScottish orBangladeshiBritish

Chinese,ChineseScottish orChineseBritish

OtherAsian,AsianScottish orAsianBritish

African,AfricanScottish orAfricanBritish

OtherAfrican

Caribbean,CaribbeanScottish orCaribbeanBritish

Black,BlackScottish orBlackBritish

OtherCaribbeanorBlack

Arab,ArabScottish orArabBritish

Otherethnicgroup,pleasewritein


Doyouhaveaphysicalormentalhealthconditionorillnesslastingorexpectedtolast12monthsormore?

Yes No

Doesthisconditionorillnessaffectyouinanyofthefollowingareas?

Pleasetickallthatapply

Vision(forexampleblindnessorpartialsight)

Hearing(forexampledeafnessorpartialhearing)

Mobility(forexamplewalkingshortdistancesorclimbingstairs)

Dexterity(forexampleliftingorcarryingobjects,usingacomputerkeyboard)

Learningorunderstandingorconcentrating

Memory

Mental health

Staminaorbreathingorfatigue

Sociallyorbehaviourally(forexampleassociatedwithautism, attentiondeficitdisorderorAspergers’syndrome)

Other,pleasewritein

application form - aberdeenshire · the scottish welfare fund – application form 9 about money...

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