Crisis and hardship grants request form

As we're receiving an increased number of grant requests currently, we are prioritising applications based on the initial information we receive. Funding will be given to those worst affected by coronavirus so please give us as much information as possible and we will attempt to get back to you as soon as we can. If you are concerned about paying your rent, please contact your income officer to discuss how we can help. We can only support LiveWest customers who cannot access support to meet their needs through other routes and will expect customers to show what government or community support they have already accessed. These grants are available to LiveWest customers, to cover specific needs, rather than to provide general funding or income. You will be asked to confirm specific costs within your application.

Please tick this box to confirm that you understand the information above and would like to apply for a grant.

First name

Last name

Address

Address 2

City/Town

ZIP/Postal Code

Telephone number

Email address

Name of LiveWest colleague supporting you with this application (if relevant)

I would like support with

paying my rent

accessing benefits

my finances or debts

accessing support around a disability or vulnerability

a specific household cost

housing, ASB or neighbourhood issues

other

Please provide details of any support needs you have selected above.

Provide details of what you would like grant support for. Please list all items and their costs.

Please provide details of how you or your family has specifically been affected by coronavirus.

Please provide details of you or your family’s current situation and how this grant will help.

Please tick any of the following that apply to you:

I pay my rent through Housing Benefit

I have previously accessed support through the LiveWest Tenancy Sustainment team

I have prevously recived a LiveWest grant

there is one or more children under 12 years of age living in my home

I currently receive Universal Credit

I am over 70 years of age or retired

I receive benefits

As a result of coronavirus have you experienced any of the following:

a change in financial circumstances

loss of employment, reduction in working hours or been furloughed

expericned a delay in receiving a new benefit claim

change to an existing benefit claim

are in debt or financial concerns

other

We normally only offer grant support to customers who do not have historic rent arrears. We will check our records to verify this information. Do you currently have rent arrears? If so, please explain how this is being managed?

Please provide details of any alternative support or funding you have accessed or attempted to access from the government or other organisations?

How did you hear about our grants?

LiveWest website

Facebook

Your housing officer

our Tenancy Sustainment team

A LiveWest collegue

other

Signature

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