Household Support Grant Application Form

Are you completing this form on behalf of someone else?

if yes, please indicate the organisation you work for, such as Broxtowe Borough Council or CAB?

If you are completing this on behalf of someone, please tell us your name

The following questions are for the information relating to the person needing the support

Name

Address

Telephone Number

Email address of person claiming

Do you pay rent to Broxtowe BC for your house?

Have you already requested vouchers through the Household Support Grant from another organisation - for example citizens advice?

Number of Adults in your household, including yourself?

Number of Children in your Household?

If you have children in your household, please indicate their ages

Does your household receive free school meals?

Children eligible for Free School Meals will already have had food provided during term time and school holidays – therefore applications for food for those children entitled to free school means will not ordinarily be approved.