Enquiry Form

Please note: If you have answered ‘NO’ to any of the questions above, we are unlikely to be able to help you unless there are exceptional circumstances – If there are, please explain what they are in the ‘your own words’ section below.

Your Details

IF WE MAY BE ABLE TO HELP YOU WE WILL SEND YOU AN APPLICATION FORM IN DUE COURSE. IF YOU DO NOT RECEIVE A FORM YOU HAVE NOT BEEN SUCCESSFUL ON THIS OCCASION. HOWEVER, WE WILL KEEP YOUR ENQUIRY FORM FOR THE REST OF THE YEAR AND CONTACT YOU SHOULD FUNDING BECOME AVAILABLE.

A grant from 3H Fund is discretionary and subject to available funding. It is not guaranteed. Please see our website www.3hfund.org.uk for guidelines, terms & conditions and criteria in full.

Low Income Assessment

Low Income Threshold: If your TOTAL HOUSEHOLD annual income is £30,000 or less, you may be eligible to apply for a grant.

Please write in the weekly/monthly amount you receive for each benefit/source of income. IF NO BENEFIT IS RECEIVED, PLEASE PUT IN A ZERO

Means Tested Benefits:

Income Support
£
Employment Support Allowance
£
Working Tax Credits
£
Child Tax Credits
£
Income-based Jobseeker's Allowance
£
Incapacity Benefit
£
Pension Credit
£
Universal Credit
£
Do you receive Housing Benefit?
If yes, please state amount:
£
If yes, is it paid directly to your landlord?

Non-Means Tested Benefits:

Full or Part Time Work
£
Disability Living Allowance/PIP
£
Child Benefit
£
Carer’s Allowance
£
State Pension
£
Other Income/benefits
£

If you do not receive any of the above, further information may be needed to complete your application. In exceptional circumstances we may consider bank statements.

Data Protection

Under the data protection regulations 1998 and to comply with new regulations coming into effect from 25 May 2018, we need your consent in respect of the following, and would be grateful if you would tick your agreement in the boxes provided:

1. All your personal data shall be kept confidentially by 3H for a time deemed necessary. 2. 3H will forward your personal data to the necessary parties who will have been made aware of their obligations to abide to all aspects of the new data regulations and particularly in respect of confidentiality and safe keeping. 3. 3H Fund may wish to publish photographs with your first name and/or short video clips which include you, in their various publications, 3H website, Facebook, Twitter and may use your details for other promotional and reporting purposes.

Under the new regulations you have the right to request personal data held about you by us and following your request this information will be returned to you within a month.

By submitting this form, I agree to 3H Fund keeping my details in accordance with their Data Protection policy

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