Funding for Individuals Application Form

Please read the Funding for Individuals Guidelines before applying.
 Download: Funding for Individuals Guidelines (pdf)

Download: Funding for Individuals Application Form

You must be referred by a recognised organisation, who will complete the referral form on your behalf. Click here: Referral Form Download: Referral Form 

 
SECTION 1 – Tell us about yourself
Full name *
Full name
SECTION 2 – Tell us about who you live with
SECTION 3 – Tell us about yours & your partner’s health
Your health
Tick relevant box
Your partner's health
Tick relevant box
SECTION 4 – Reason for application
Please tick your current circumstances *
Tick relevant box
SECTION 5 – Tell us what you are applying for
Household Funding
Tick relevant box
Transport Funding
Tick relevant box
Funding for Children & Young People
Tick relevant box
Vocational Funding
Tick relevant box
SECTION 6 – Tell us about how much you are applying for
SECTION 7 – Tell us about your finances
Please provide your latest bank statement to support your application (less than 1 month old)
- Failure to provide full financial details may result in your application being refused. - Your personal information will be destroyed or returned after the assessment of your application. - Walton Charity reserves the right to additional information in support of your application. - Walton Charity's staff may contact successful applicants 3/6 months after receipt of funding as part of our standard evaluation procedure.
I declare that the content of this funding application form and all supporting documents are correct and I understand that any misleading infomation may result in my application being refused

By completing this form you are acknowledging our Privacy Statement and sharing protocol which can be found at: www.waltoncharity.org.uk/privacy

CONTACT DETAILS

Amina Lawson
0203 328 0246 or alawson@waltoncharity.org.uk
01932 220242 or admin@waltoncharity.org.uk

Charities House
1&2 The Quintet
Churchfield Road
Walton on Thames
Surrey, KT12 2TZ