Hardship Fund Application

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Your Needs
Please explain the financial difficulty you are in and the reasons for this.*
AMOUNT YOU ARE REQUESTING FROM THE STAFF HARDSHIP FUND? (MAX £2500)*
Please enter a value less than or equal to 2500
Please enter a value between 0 and 2500.
Please provide a full breakdown of the financial support you are requesting and how you plan to use any funds provided.*
Please explain where else you have looked to for support (e.g. helplines, benefits office, Care Workers Charity, Turn2Us, etc.)*
Is There An Independent Person (I.e. A Non-family Member) Whom We Could Contact To Verify Your Situation, Such As Your Manager, Social Worker, Debt Advisor, Etc.?*
- Yes
- No
Title*
First Name*
Last Name*
Relationship to you*
Email*
Enter Email Confirm Email
Contact person phone

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Your Financial Position

Please provide details of your current financial position. Please ensure that the information you provide is accurate and up-to-date.

Please provide details of your current financial position, including:

Income
AVERAGE MONTHLY INCOME:*
MONTHLY BENEFITS:*
ANY CASH, SAVINGS AND/OR INVESTMENTS:*
ANY ASSETS YOU OWN (PROPERTIES OTHER THAN THE HOUSE IN WHICH YOU LIVE, GOLD, SILVER, ETC):*
Expenditure
YOUR AVERAGE MONTHLY OUTGOINGS (RENT, GAS, CHILDCARE, FOOD, TRAVEL, PHONE, ETC):*
Please provide details of main outgoings*
ANY DEBTS - TOTAL AMOUNT*
MINIMUM MONTHLY PAYMENT*

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Supporting Documents

Please provide any supporting documents to substantiate your application.

Applicant's proof of ID (i.e. photo ID, passport or driving license) | Any other helpful documents relating to your application | Allowed file extensions: pdf, doc, docx, xls, xlsx | Maximum number of files: 5 | Maximum file size: 5MB
Drop files here or*
Accepted file types: pdf, doc, docx, xls, xlsx.

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Declaration and Consent
Have You Made An Application To The Staff Hardship Fund Before?*
- Yes
- No
Please give details
Contact Permission
We would like to keep in touch with you about the work the Hardship fund is doing, any events we may have or opportunities to further get involved with the Hardship fund. Please let us know if you would like to be kept informed by selecting one of the options below. You can find out more about our privacy policy on the Privacy page. You can manage your data via our Privacy Tools page.
Yes please, I would like to be kept informed about Evoke Care Hardship fund*
- Yes please, I would like to be kept informed about Evoke Care Hardship fund
- No thanks, I do not want to be kept informed about Evoke Care Hardship fund
GDPR AGREEMENT
I consent to my submitted data being collected and stored*
- I consent to my submitted data being collected and stored
You can find out more about our privacy policy on the Privacy page. You can manage your data via our Privacy Tools page.
Declaration

I CONFIRM THAT ALL INFORMATION PROVIDED IS TRUE TO THE BEST OF MY KNOWLEDGE.
Title*
First Name*
Last Name*
Date Of Application*

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Staff Hardship Fund application