Funding for Individuals Referral Form

Please ensure that you have given instruction to the applicant to provide the full completed Funding Application Form, together with their latest bank statement.

Click to download the Referral Form.

SECTION 1 - Referring Organisation Details
Name *
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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CONTACT DETAILS

Amina Lawson
0203 328 0246 
alawson@waltoncharity.org.uk

Or

01932 220242      admin@waltoncharity.org.uk

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