Family Circumstances (WIP) Content to be added Family Circumstances "*" indicates required fields Applicant detailsName* First Last Date of birth*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Address* Street Address Address Line 2 City ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Phone*Email* DemographicsGenderMaleFemaleNon-binaryAgenderMy gender is not listedPrefer not to answerEthnicityArabAsian/Asian British: BangladeshiAsian/Asian British: ChineseAsian/Asian British: IndianAsian/Asian British: PakistaniAsian/Asian British: OtherBlack/Black British: AfricanBlack/Black British: CaribbeanBlack/Black British: OtherMixed: White and AsianMixed: White and Black AfricanMixed: White and Black CaribbeanMixed: OtherWhite: British/English/Northern Irish/Scottish/WelshWhite: Gypsy or Irish TravellerWhite: IrishWhite: RomaWhite: OtherAny other ethnic groupMarital statusSingleMarriedDivorcedWidowedSeparatedDomestic PartnershipAccommodation typeHomeowner outrightHomeowner with a mortgageHomelessLiving with friends/familyLiving with parentsPrivate rentedRoom in a house shareShared ownershipSocial tenantTemporary housingRefugeOtherDoes the applicant identify as being disabled? No Yes Does the applicant identify as having a mental health condition? No Yes Does the applicant identify as having a physical health problem? No Yes Living situationDoes the applicant live with a partner?* No Yes Are there any children under 18 in the household?* No Yes What are their ages? Public fundsDo you have a No Recourse to Public Funds order?* No Yes FinancesEmployment status* Employed Full-Time Employed Part-Time Self-employed Not employed and looking for work Not employed and not looking for work Homemaker Retired Student Partner's employment status (if applicable) Employed Full-Time Employed Part-Time Self-employed Not employed and looking for work Not employed and not looking for work Homemaker Retired Student Does the household receive any welfare benefits?* No Yes Which ones? Disability Living Allowance (DLA) Carer's Allowance (CA) Universal Credit (UC) Child Benefit (CB) Housing Benefit (HB) Other Is the applicant currently bankrupt or in an IVA?* No Yes Does the applicant have permission from their insolvency practitioner to receive grants? No Yes Has the family received any other grants in the past 12 months?* No Yes Personal circumstancesWhat is the life changing event that has happened to the family in the last year?*Please be as detailed as possible.What impact has that life-changing event had on the family financial situation?*Please be as detailed as possible.What future goals and ambitions would the family like to achieve with a financial grant?*Please be as detailed as possible.Privacy Promise (please read this to the applicant and confirm their consent)* Applicant agrees to the Turn2us Privacy PromiseTurn2Us will always store personal details securely. It will use your personal details to provide the service requested and communication in the way(s) that you have agreed to. The data may also be used for analysis purposes, to help Turn2Us improve its services and communicate with you most effectively. Turn2Us will only allow personal information to be used by third parties working on its behalf and will only share it to deliver a service to you or if required to do so by law. For more details about how Turn2Us processes personal data please visit the Turn2us privacy policy on their website, or email consent@turn2us.org.uk. By giving us your details you agree that we can process your information according to the terms of our privacy policy. CAPTCHANameThis field is for validation purposes and should be left unchanged. Δ
