RSF application form

REFUGEE SUPPORT FUND APPLICATION

To make an application, please complete and submit the form below. Or you can download a copy and post it to Elmbridge CAN, PO Box 112, East Molesey, KT8 8EN.

Please ensure you complete ALL sections marked with a * or the form will not submit.

WHO IS THE GRANT FOR?

* Indicates required field

Name *

First

Last

Address *

Line 1

Line 2

City

State

Zip Code

Country

Email address *

Date of arrival into the UK *

BRP/ARC number *

Is the applicant under 16? *

Yes No

Name of referring organisation / individual *

ABOUT THE GRANT

How much are you applying for? *

Please explain what the grant is for - include links to items/websites if possible or an estimate of cost for each item *

How do you think this grant will make a difference to your life? *

Please provide a brief explanation of your benefits situation *

Please use this space to provide any other information you think is relevant to help us to assess your application *

Do you need the decision by a specific date? *

Yes No

If yes, when? *

Please confirm whether you are happy for us to contact you to discuss what additional support we may be able to offer. *

Yes No

Submit

Notes:

By submitting this form, you consent to the collection and use of information by Elmbridge CAN in accordance with our Privacy Policy.
We will usually require valid receipts before grants are dispensed.
If we have any queries about your application, we will contact you to discuss it further.
In some cases, we might suggest that we help meet your needs through another route eg. sourcing good quality donated items rather than purchasing new, or accessing more suitable grants from other organisations or your local authority.

Get Involved >

REFUGEE SUPPORT FUND APPLICATION

e: contact@elmbridgecan.org.uk

f: www.facebook.com/elmbridgecan

Elmbridge CAN | PO Box 112 | East Molesey | KT8 8EN