Household Support Grant (Food Vouchers)

Label

Parent/Guardian First and Last Name*
Parent/Guardian National Insurance Number*
Parent/Guardian Date of Birth*
Address
1. Label
  2. Address Line 1*
  3. Address Line 2
  4. Address Line 3
  5. Town
  6. Postcode*
Contact telephone number*
Please enter an 11 digit UK Phone Number. Do not add the country code (+44)
Email Address*
Please note you will not be eligible for a grant payment for assitance with your utility costs.
Do you have children aged 0 to 5
1. Yes
2. No
PEOPLEWITHCHILDREN
1. Please select which of the eligibility criteria applies to you below (You must select at least 1)
  
  In receipt of Income Support
  
  In receipt of income-based Jobseeker’s Allowance
  
  In receipt of income-related Employment and Support Allowance
  
  In receipt of the guaranteed element of Pension Credit
  
  Child Tax Credit – as long as you’re not also entitled to Working Tax Credit and your annual gross income is no more than £16,190
  
  Working Tax Credit run-on (paid for four weeks after you stop qualifying for Working Tax Credit)
  
  Universal Credit – your household income must be less than £7,400 a year after tax and not including any benefits you get
  
  A household with no recourse to public funds and you are known to the council’s adult or children’s social care team
2. Number of dependent children under 5 NOT in full time education, living in the household
3. Child 1
  1. Full Name
  2. Child Date of Birth
4. Child 2
  1. Full Name
  2. Child Date of Birth
5. Child 3
  1. Full Name
  2. Child Date of Birth
6. Child 4
  1. Full Name
  2. Child Date of Birth
7. Child 5
  1. Full Name
  2. Child Date of Birth
8. Number of children attending an Independent SEN provision (Special Educational Needs School)
9. Child 1
  1. Full Name
  2. Child Date of Birth
  3. Name of school
10. Child 2
  1. Full Name
  2. Child Date of Birth
  3. Name of school
11. Child 3
  1. Full Name
  2. Child Date of Birth
  3. Name of school
12. Child 4
  1. Full Name
  2. Child Date of Birth
  3. Name of school
13. Child 5
  1. Full Name
  2. Child Date of Birth
  3. Name of school
14. Number of adults of State Pension Age in the household*
15. Number of people with a disability in your household*