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
Your full name *
Your full name
SECTION 2 – Tell us about who you live with
SECTION 3 – Tell us about yours & your partner’s health
Applicant’s health /disability
Tick relevant box
Partner’s health /disability
Tick relevant box
SECTION 4 – Reason for application
Please tick your current circumstances *
Tick relevant box
SECTION 5 – Tell us how we can help you
Household Funding
Tick relevant box
Transport Funding
Tick relevant box
Funding for Children & Young People
Tick relevant box
Vocational Funding
Tick relevant box
SECTION 5A - White Goods or Utilities Arrears
Tick relevant box
SECTION 5B – Transport & Childcare
SECTION 5C – School Holiday Club & Extra Curricular Activities
SECTION 5D – School Trip
SECTION 5E - Course Fees & Accreditation
Type of study
SECTION 5F – Course Kit, Uniform & Materials
SECTION 6 – Tell us about your finances
Please provide written proof of income and expenditure, including latest bank statement (1 month old), when you attend your appointment with us
INCOME
Weekly
(eg maintenance payments)
EXPENDITURE
Weekly
(e.g. hair cuts, after school clubs, magazines, cigarettes)
DEBTS
I confirm this to be as accurate record of my income, expenditure and debts as I am able to provide. Please note your personal information will be destroyed or returned after the formal assessment of your application.

Data Protection and Sharing Declaration
Walton Charity may share your personal information with other organisations in order to verify information supplied or to assist you to receive a service. Walton Charity will share your personal information, without your consent to assist with the prevention or detection of crime. You have the right to request a copy of the personal information we hold about you. If you would like a copy of some or all of this please contact Walton Charity on 01932 220242 or email admin@waltoncharity.or.uk.

Walton Charity is a signatory to Surrey County Council’s Multi Agency Information Sharing Protocol full details of which can be found here: 
Please note that if you are unable or unwilling to provide some or all of the information we have asked for, we may be unable to offer you assistance. I have read and understood the above and consent to Walton Charity using the personal information I have given them and sharing it as outlined above.

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