Household Support Fund for parents/carers - Surrey Coalition of Disabled People

If the answer to the above question is 'yes', please let us know the organisation you are referring from?

Name of child(Required)

Full name of parent/carer(Required)

Address of child(Required)

Please upload any proof of address (in parent/carer name) - this could be a utility bill, bank statement, driving licence or council tax bill. If you are not able to upload it, you can send it to our postal address too.

Max. file size: 40 MB.

If you are unable to provide proof of address, please let us know why.

Date of birth of child(Required)

Email address of the parent/carer(Required)

Phone number of the parent/carer(Required)

How many people are there in the household?(Required)

How many children in the household?(Required)

If other, please let us know how much you'd like to apply for?

Please provide evidence of your need? (in parent/carer name) For example an energy bill, bank statement or similar.

Max. file size: 40 MB.

Please give details of why the child needs the amount specified. For example, what is the nature of your child's disability and how does it result in your living costs being higher than they would be otherwise? This could be that particular equipment that needs to be run or additional items that need to be purchased for example(Required)

Please write a minimum of at least 10 words

Please specify supermarket voucher request

Please note - we can’t guarantee that we’ll be able to get your requested supermarket voucher.

Please let us know how you'd like to receive the grant?

Please give the name of your energy supplier and your account number if selected support with your energy bills

hCaptcha(Required)

If the captcha is an issue for you completing the form please contact: Involvement@surreycoalition.org.uk Phone: 01483 456558 SMS: 07908671402