Individual Grants Referral Form

Please ensure that you have given instructions to the applicant. They will need provide to complete the Individual Grants Application Form. They will also need to email or post their latest bank statements at

Click to download the Referral Form.

SECTION 1 - Referring Organisation Details
Name *
SECTION 2 - Applicant’s Details
Current address, including postcode *
Current address, including postcode
Health & disability
Are there any concerns regarding lone working?
SECTION 3 – Support Required
Household Funding
Transport Funding
Funding for Children & Young People
Vocational Funding
SECTION 4 – Statement & Other Support

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Amina Lawson
0203 328 0246

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