Cornwall Council Covid Winter Grants Scheme Application Form Cornwall Council Covid Winter Grants Scheme Application Step 1 of 7 14% About this form Save and Continue Feature Please note, this application form can be saved partway through. Please click the Save and Continue Later link at the bottom of any page. You will be asked to supply your email address and you will be emailed a link to your application form so that you can continue to complete it at a later date. All questions marked with an asterix* require an answer and cannot be skipped. You will need to complete all questions with an asterix* before moving onto the next page. If you are not sure how to complete this form or need help with any other queries relating to the grant, please speak to your support worker. Have you read and understood the Terms and Conditions that accompany this application form?*YesNo - please get in touch with us with any queries before continuingName of carer*Contact address and postcode*Daytime telephone number*Email* Name of support workerSupport worker's contact numberSupport worker's emailWho do they work for?Must be one of these 2 organisationsKernow Carers ServiceInclusion MattersWould you like a follow up call from a Carer Support Coordinator regarding information, advice and guidance that might be appropriate for you?Yes pleaseNo thanks About your caring roleWho are you currently caring for?*What is their diagnosis/condition?*Can you tell us about the impact of your caring role on your daily life, your sense of wellbeing and your health?*Are there any children under 18 years in your household?*YesNo What will the grant pay for? This must be linked to reducing financial hardship and food poverty.Please tell us what you would like funding for*How will the winter payment improve your circumstances?*How much money are you applying for?*Costings*Please click the + symbol at the end of each row to add another rowItem (for example - purchase of food items, money towards utility bills, purchase of essential items for the home, clothingTotal cost Your bank details If your application is successful, payment will be made directly into your bank account. Bank or building society*Account name*Account number*Sort code* Declaration and agreement*Please tick all boxes to indicate your agreement I agree to the Terms and Conditions of the Covid Winter Grant Scheme as they are set out in the guidelines that accompany this application form. I agree to complete a feedback report on how the grant was spent and how it has helped the group. I have read the Data Protection statement in the Terms and Conditions and agree to how CRCC will hold/use my details. I confirm that the information provided in this application is true and accurate to the best of my knowledge. * I confirm that if I am unable to sign this form electronically, I consent to a Carer Support Coordinator to sign on my behalf. Date* Date Format: DD slash MM slash YYYY Application deadlines: Final applications at the end of the day 31 March 2021 Data Protection CRCC complies with the EU General Data Protection Regulations and the Data Protection Act 2018. By sending this form to us, you agree that we can securely store your personal information on our database or in the form of paper records, and that we can use your information in order to provide a service to you as part of the Covid Winter Grants Scheme. We will only collect and process information in accordance with the legal basis for the service you are receiving. We will not sell your information or share it with any other organisations. We will not keep this information longer than necessary (this is normally for two years following the end of the contract year); it will then be securely destroyed. Our full Privacy Statement is available on request and can be viewed on our website at dataadmin@cornwallrcc.org.uk
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