Thank you for taking a look at this grant.
Please be aware that this is a limited fund to assist with household essentials - this fund is operating for the period 2nd October 2023 to 31st March 2024. Applications relate to the physical household as much as to your family's living arrangements. Therefore, there can only be one application per household in this period.
Consent to Privacy Policy* Consent to hold data within our case management system and share selected applications with other members of the Wokingham Hardship Alliance, such as Age UK Berkshire, to aid the approval process.
Tick to accept and proceed
Information about you and your household.... Your Full Name*
First
Last
Your Date of Birth* Your Gender* Please Select Male Female Prefer a different term Prefer not to say
Ethnicity This is not a mandatory question to answer - we are asking so that we can understand more about the demographics of the people this grant is reaching. This helps us to review the grants reach and adapt our approach as we continue.
White (British) White (Irish) White (Gypsy or Irish Traveller) Other White Background Mixed Ethnic Groups (White and Black Caribbean) Mixed Ethnic Groups (White and Black African) Mixed Ethnic Groups (White and Asian) Other Mixed / Multiple Ethnic Background Asian / Asian British (Indian) Asian / Asian British (Pakistani) Asian / Asian British (Bangladeshi) Asian / Asian British (Chinese) Other Asian Background Black / Black British (African) Black / Black British (Caribbean) Other Black / Black British Arab Other Ethnic Group
Your Address*
Have you or anyone in your household applied to the Household Support Fund since 1st October 2023?* We can only accept one application per round (anytime between 1st October 2023 to 31st March 2024 - if you have had an application rejected, please reply to the email to discuss.)
We can only accept one application form per household unless in a House of Multiple Occupation (HMO) and unrelated - it will be automatically rejected. If you're in a HMO and unrelated to another applicant, please complete this form and email householdsupportfund@cawokingham.org.uk
Can We Leave a Voicemail if Necessary?* Can We Send a SMS Text if Necessary?* Email Consent to be contacted for further cost-of-living support updates* Do you consent to Wokingham Borough Council using the supplied contact email address to send you further updates about cost of living support?
Can we send you a letter?* We will only do this if needed - for example, if we have no email address to contact you about your application
Your Household* Please select the best option that describes your household. Your household is your family members that live with you.
Please Select... Single Person Household Couple Household Single Person Household with dependent children Couple Household with dependent children Single Person Household with non-dependent children Couple Household with non-dependent children Household with Pensioner(s) Household with Disabled Person(s) Other
Please describe your Household* As you chose 'Other' please describe your household
Does anyone in your household have a disability?* Is anyone in your household a carer for a sick, disabled or elderly person?* Name(s) of Other Adults in Your Household Please provide the names of all other adults (18 or over) in your Household. Use the + symbol to add more rows.
Information about the amount of money you have to live on each month.... Is Your Household In Receipt of Means-Tested Benefits?* Means tested benefits are those that you are entitled to if you are on a low income, such as Universal Credit
Budgeting Tool Please complete the Budget Tool .
When complete it will allow you to save as PDF at the bottom of the second page.
(When clicking the link it will open in a new tab. If you have any issues with this you can always email it to us later on and skip it for now)
Is Your Household in Receipt of Universal Credit?* Do You Have an Online Journal?* What Legacy Benefits is Your Household in Receipt Of?* These are benefits that pre-date Universal Credit and that you may still be in receipt of
What is the total amount of income your household receives each month?* Household income is defined as all income coming into the household from adults aged 18 or over from earnings, employment and self employment, benefits, pensions and income from savings and investments. Please do not include income from health related benefits such as DLA, PIP and Attendance Allowance. Please also do not include earnings from any young person who is still in full time education (school, sixth form or college)
If your household includes 2 or more adults please give the total income for your whole household.
Please Select... £799 or less £800 - £999 £1,000 - £1,300 £1,301 - £1,499 £1,500 - £1,999 £2,000 - £2,499 £2,500 or more
Do you have any savings and capital?* Savings and capital is defined as money you have in bank accounts, in any type of investment (including ISAs), and in ownership of valuable assets such as other property. Please do not include the home you live in or other assets you need day to day such as cars you need for work or childcare.
What essential support do you need.... An award from the Household Support Fund is capped at a maximum amount. You will not get more support because you have listed needs in every category.
Help to pay Household Energy and/or Water Bills* Household energy is Gas, Electric, Oil and Solid fuels
Please Select... Yes: I have pre-payment meters Yes: I don’t have pre-payment meters No
Help with essentials linked to energy and water* These could include sanitary products, warm clothing, soap, blankets, boiler service / repair, purchase of equipment including fridges, freezers, ovens, etc.
Please Select... Yes (please explain in detail below) No
Help With Food Costs* This is NOT for Free School Meals eligibility - please contact First Days for that support https://www.firstdays.net/
Please Select... Yes No
Help with housing costs* In exceptional cases of genuine emergency where existing housing support schemes do not meet this exceptional need, the Fund can be used to support housing costs. The Fund cannot be used to provide mortgage support, though homeowners could still qualify for the other elements of the fund (such as energy, food, water, essentials linked to energy and water and wider essentials).
Please Select... Yes (please explain in detail below) No
Help with wider essentials* Please list them below
Please Select... Yes (please explain in detail below) No
Help to Pay for Housing Costs or Something Else That I/We Consider Essential* Please explain what else it is you need help with or what your housing emergency situation is
If accepted, please tell us how you'd prefer the support* Please Select... Voucher redeemable as cash at a paypoint Food Voucher Fuel Voucher for pre-payment meter
If you chose food vouchers, they have to be assigned to a particular supermarket, which one would you choose?* Aldi Asda Iceland Lidl Morrisons Sainsburys Tesco
Are you able to access a voucher online if delivered by email?* Where possible, vouchers will be sent to you by email. The voucher can be accessed by clicking on a link to a website. You do not need to print the voucher out to use it.
Please Tell Us The Main Reason for Needing Support from the Household Support Fund* Please Select... Increased bills and cost of living Loss of benefits Low income My/Our income from earnings has dropped Reduced hours at work Keeping up with debt repayments Sickness or ill health Relationship Breakdown Something else
Please Explain What Else*
Advice from Citizens Advice Wokingham Would you like to be contacted by our Energy Advice team for help with saving energy? After receiving this grant, would you like advice from us on any of the issues you're dealing with?* Please tick the areas you would like advice in, and provide any further details of your issue* Additional Information required - please can you give us more details about how we may be able to help or what your issues are* Please provide some detail about what help you require from our free advice, information and support service
How would you prefer to be contacted?* A member of our team will contact you to discuss the issues you indicated above. Please let us know how you would prefer them to contact you
When is the best time to call you? Our operating hours are Monday to Friday, 9:30am to 4:30pm
Evidence to support your application.... It is important to provide us with the evidence we have asked for below . If you are unable to this will delay your application as we will need to ask for it via post, via email or in person. We cannot make an award without the evidence under the eligibility rules .
Agreement* Obtain Proof of You Universal Credit - Online Journal Make sure any screen shot includes where it shows your name and address
Obtain Proof of You Universal Credit - Telephone Claim Make sure the photograph includes your name and address as well as the payment
Upload Proof of Your Universal Credit* Upload Proof of Your ID and Wokingham Borough Address* Please provide a photograph or scanned image of official documents proving your ID and/or address. For example, a driver's license, council tax bill, letter from Wokingham Borough Council or HMRC can be used for both ID and address; A passport can be used for ID only; A utility bill, or bank statement can be used for proof of address only.
Please email copies to householdsupportfund@cawokingham.org.uk
If we do not receive this within 7 days of your application we will contact you to help with providing evidence. This will delay your application.
Upload Proof of Your Means Tested Benefits* Please provide a photograph or scanned image of a benefit award letter from DWP, HMRC or Wokingham Borough Council, that is no more than 6 months old. If you only have an older letter please upload it but ALSO upload a bank statement showing payments of this benefit(s) in the last month. The bank statement must show your name and address.
Upload your Latest Bank Statement or Screen Shots of Online Banking Transactions* This must cover a full calendar month and be a period within the last 3 months. Screen shots of online banking must show your name as well as transactions. Please provide multiple screen shots if required. If you have more than one bank account please upload the latest bank statement for each account
Upload Proof of Larger Family* Please provide evidence of at least four people in your household.
If you are receiving benefits such as Universal Credit, Tax Credits or Child Benefit, please provide the pages from your most recent statement showing number of dependent children.
For other adults in the household, please provide an official document such as a bank statement
Upload Proof of Disability* Please provide a photograph or scanned image of a benefit award letter for DLA, PIP, ESA, or AA, that is no more than 6 months old and addressed to someone in your household. If you only have an older letter please upload it but ALSO upload a bank statement showing payments of this benefit(s) in the last month. The bank statement must show your name and address.
Upload Proof of a Carer Benefit* Please provide a photograph or scanned image of a benefit award letter for CA, that is no more than 6 months old and addressed to someone in your household. If you only have an older letter please upload it but ALSO upload a bank statement showing payments of this benefit(s) in the last month. The bank statement must show your name and address.
Completion and Declaration.... Did Someone Help You to Fill in This Form?* This could be a friend, a family member, or a member of an organisation. Please provide their details below.
Their Name*
First
Last
Consent to contact Please tick here if you give your consent for us to contact this person and discuss the application on your behalf.
I consent.
Would you like us to send a copy of this application to you? Please be aware that any email we send will come from householdsupportfund@citizensadvicewokingham.org.uk - this may end up in your Junk/spam folder so please check
Declaration - Please note it could take us at least 10 working days to get through your application, possibly longer depending on the volume. We will contact every single person that applies.* I confirm that the information I have provided in this application is accurate and a true representation of my/our household.
I confirm.
Before you click 'Submit Application' please read below Please ensure you have attached all the evidence requested or can either email it over to householdsupportfund@cawokingham.org.uk, post it to us or drop it in to one of our offices. Otherwise your application may be significantly delayed.Once you have clicked on SUBMIT APPLICATION below, please ensure that you see the "APPLICATION SUBMITTED SUCCESSFULLY" screen. If you do not see this screen, you may have missed some required fields on the form. Missing fields will be highlighted in red: please complete these fields and click SUBMIT again.
