Application Form – Wembley Compassionate Fund

Before using this form, please read the guidance on our Referrals from Professionals page

Our application form requires your consent to our use of the information, so please read our data protection policy before completing this application by clicking on this link Privacy and Data Protection

We will, in due course, notify the applicant that you have made this application on their behalf

Fields marked * must be completed

Proposer's Name *

Proposer's Email *

Confirm Email

Proposer's telephone number *

Proposer's role *

Proposer's Address *

Applicant's Name *

Applicant's email

Applicant's telephone number *

Applicant's address *

Applicant's hours worked *

Applicant's household income (please itemise all sources and amounts) *

Applicant's benefits received (please itemise all sources and amounts) *

Applicant's outstanding debts (please itemise all debts) *

Applicant's outgoings (please itemise all commitments) *

Applicant's family status (please select) *

Additional information if family status is "other"

Age(s) of dependent child(ren)

Do children live with applicant?

Prime needs and qualifying comments (please also mention any disabilities or other health issues that need to be taken into account in implementing any award) *

Please check the boxes below to confirm consent to our use of your personal information. *

I have read the Wembley Compassionate Fund (WCF) data protection policy and I agree to my information being used by the WCF to contact me (by telephone, by email, or in writing) and for keeping appropriate records.
I have informed the applicant of the WCF data protection policy and have obtained the applicant’s consent to the information in this application being used by WCF to decide on this application, to contact them (by telephone, by email, or in writing) and for keeping appropriate records.

Email *

Website