How to Complete this form
Any sections marked with a * must be completed before submitting. Please remember to include a telephone number (where possible) as most of our partners will make initial contact by telephone.
How We Can Help
In this section please give more information about the help you need. The list below asks some questions you could use to give us more details on the help required:
Help with Benefits/Pensions/Allowances: Do you currently receive any benefits? Are you employed? Do you have any children? Do you have any health issues?
In the Home: Is your home warm? Do you get cold draughts within your home? Do you have high fuel bills? Need home repairs or adaptions?
Debt/Borrowing/Managing your money: Do you have any debts? If you have debts what kind e.g. credit cards, store cards, catalogue payments, rent arrears etc. Do you want advice on saving or loan options? Need budgeting advice or information about low cost foods?
Getting Back to Work: Need help with CV or job applications? Want to improve your interview/ computer skills? Looking for training/ volunteering opportunities?
Health & Care: Want to improve your health and wellbeing? Would you like information about healthy eating, stop smoking, exercise or free health check? Do you need help or support as a carer or someone coping with a long term illness or disability?
Please note: The questions above are just a guide to give you an idea of the information required. If these do not cover the financial advice that you need please give us details on the help or information you would like.