CARE Support Request Form

Do you want to request help or make a referral for help on behalf of someone else?*

I want to request help

I want to refer someone for help

Please enter your password*

Passwords are case sensitive.

Do you have a referral number?*

Please ensure you select the correct option. Failure to do so will invalidate your request and it will not be processed. A referral number starts with R- followed by a 7 digit number.

Yes

That’s not a problem… we can still help you! If you are requesting pastoral care, please ignore this message and continue with your request.

If you’re requesting a food parcel, the process is slightly different…

We can give you up to three food parcels in a calendar year (between January and December each year) without a referral number.

If you need more food parcels after this, you will need to get a referral from one of our partners.

Getting a referral number is easy and straight forward, and will enable you to have ongoing support for 90 days, where you can request a food parcel each week, full of cupboard food, fridge food, and frozen food.

There are lots of people who can refer you, from schools, to health visitors, social services, to support workers. If your situation still hasn’t improved after 90 days, you can be referred again.

To find out more about who our referral partners are and how to get a referral, please click here.

What is your referral number?*

This number must match our records exactly, otherwise we will be unable to help you. Please only put your 7 digit number in this field.

Temporary Assistance Request

Your Details

Please ensure that these details are filled in accurately. Thank you.

Name*

Telephone Number*

House Number*

Is this number for a house, or a flat?*

Address*

Enter your full address (including the house/flat number again)

Postcode*

Enter your post code with no spaces. We will only help service users within the CF83 postcode area.

Email address*

Confirm Email address*

Please confirm that you live in an area covered by the CARE Project:*

What is the request?*

Please confirm that you are in genuine need of assistance*

The CARE Project is here to help anyone who is in genuine need. This means that if you have help available to you in the form of family/friends to get food/prescriptions/click and collect deliveries, or you have the financial means to buy your own food, we are not able to help you.

I confirm

Why are you in need of assistance?*

Your Request

Your food parcel will be made up of food donated by businesses, supermarkets and other charitable enterprises. Some food contained in your parcel may be beyond it’s “Best Before” date, and some food may be frozen prior to its “Use By” date. Food that is past its “Best Before” date is still edible. We will endeavour to ensure that food allergens are labelled where appropriate, but we cannot guarantee that there has been no cross-contamination during the decanting, sorting and preparing of foods. By continuing with this request, you are agreeing that you understand this, and that any food you accept from us becomes your responsibility on transfer.

Number of Adults in household?*

Number of Children in household?*

Tailoring your request

Please let us know if anyone in your household has any dietary requirements, or whether there are any particular items you desperately need or don’t need Please remember: food is donated to us, so we cannot guarantee stock of any particular item. Also, delivery drivers will not take unwanted food back with them once it has been delivered to you.

Do you need any essential non-food items?

e.g Toothpaste, Soap, Toilet Roll, Sanitary products. We DO NOT supply clothes or pet food. Please remember that we CANNOT guarantee that these items will be available when we compile your food parcel.

Once you submit this form, a volunteer will get in touch with you to organise a mutually convenient time to collect the “Click & Collect” food shop and deliver it to you.

Your Request: A Telephone Call

Is there anything we need to know?

We want to allocate a volunteer that is suited to your needs. If you need to talk about something specific, please let us know in this box. It may also be helpful to know a little bit about you, your age, and your interests. This may mean that we are able to connect you with other people in the community. However, please don’t feel you need to fill this box in!

By submitting this request form, you are agreeing that we may hold your information in accordance with our Privacy Policy, and that we may use it to provide a service to you. Once your request is submitted, we will endeavour to action it as soon as reasonably possible. A volunteer will be in touch via telephone and/or email to confirm your details. If you do not hear from us 48 hours (Monday-Friday), please telephone The Support Line on 02921 880 212, option 0. Following completion of your request, a volunteer may be in touch to follow up and check that everything went OK.

Referred Assistance Request

Service User Details

Please ensure that these details match your referral details exactly. You CANNOT put in a request for someone else.

Name*

Telephone Number*

Email address*

Confirm Email address*

House Number*

Is this number for a house, or a flat?*

Address*

This address must match the address on your referral record.

Enter your full address (including the house/flat number again)

Postcode*

What is the request?*

Please confirm that you are in genuine need of assistance*

I confirm

Your Request: Essentials Food Parcel

Your food parcel will be made up of food donated by individuals, businesses, supermarkets and other charitable enterprises. Some food contained in your parcel may be beyond it’s “Best Before” date, and some food may be frozen prior to its “Use By” date. Food that is past its “Best Before” date is still edible. We will endeavour to ensure that food allergens are labelled where appropriate, but we cannot guarantee that there has been no cross-contamination during the decanting, sorting and preparing of foods. By continuing with this request, you are agreeing that you understand this, and that any food you accept from us becomes your responsibility on transfer.

Number of Adults in household?*

Number of Children in household?*

Tailoring your request

Do you need any essential non-food items?

Your Request: A Telephone Call

Is there anything we need to know?

Referral Form

As a referral partner, you are able to refer an individual/family to us for assistance. This assistance will last 90 days, at which point we hope that the individual or family concerned will have found a permanent solution to their crisis. If this is not the case, you may refer them again after meeting them to discuss their ongoing needs and assessing them.

Important information from July 2022

Dear Referral Partner,

Due to the Cost of Living Crisis, demand for assistance from the CARE Project has risen significantly.

As such, it is becoming increasingly more difficult to provide for everyone, especially as donations from the General Public are declining as they also feel the pinch.

Therefore, we are asking Referral Partners to exercise due diligence before referring people to ensure that they are genuinely in need. We understand that this may mean some awkward conversations, however we need to press upon you the importance of filling in this form comprehensively and giving full details of the Service User’s situation. Failure to do this will result in the referral being declined.

I confirm that I have read, understood, and will abide by the above.*

Please tick

Gathering Data*

The Parish Trust CARE Project will need to gather data about the Service User in order to provide the best service possible, and to report statistics to regulatory bodies and grant funders. We need the Service User’s understanding and consent that we will be in contact with the Service User to ask about their circumstances and how we can help them. We will not be able to offer our help without this consent.

The Service User consents

Referrer Details

Please ensure that these details are filled in accurately. Thank you.

Your Name*

Telephone Number*

Email address*

Confirm Email address*

Name of Referral Partner*

This will be the name of the organisation you work for.

What type of organisation do you represent?*

Eligibility

This section helps us to understand the Service User’s needs. Before you continue with the form, you are required to understand the following: Location of the Service User: Service Users must reside in an area we cover. They cannot claim help from us via another address such as a family member or friend. Service User’s Reason for Requesting Help: Service Users need to tell you why they have made the decision to seek to be referred to us. You can choose from one of the following options:

Unemployed – Service User has been made redundant, or is seeking employment but has been unsuccessful thus far.
Benefit Changes / Delays – A change in circumstance means that benefit has been claimed or changed, and there is a delay in them coming through to the Service User’s bank account
Debt – The Service User has debt of any kind, including credit cards and other short term debt such as overdraft/pay day loans.
Child Holiday Meals – Service User already claims free school meals and will find it a struggle to provide food through the school holidays
Low Income/Wages – Service Users who do not have any debt or who are unemployed and unable to work due to parental responsibility.
Delayed Wages – Service Users are recently employed or who are self-employed/paid by invoice
Domestic Abuse – Any victim of domestic abuse
Sickness / Ill Health – Any Service User who is ill for an extended period, has a highly infectious disease, or who has been declared unfit to work.
No recourse of Public Funds – Service User who is claiming Assylum
Housebound – Any Service User who is physically unable to go out of the house.
Pensioner Poverty – Service Users in receipt of a STATE pension that does not cover the cost of living (private pensions do not qualify).
Poor Mental Health – Service User who is suffering from difficult experiences affecting their wellbeing

Please confirm that you understand this eligibility criteria and will select appropriate answers in the following eligibility questions.*

I understand

Please confirm that the Service User lives in an area covered by the CARE Project:*

We cover areas in the following post codes: CF83, CF3 6, NP10 8. If the service user does not fall into any of these postcodes and is not listed in our list of towns/villages, we are unable to help due to limitations on funding and volunteer numbers.

What is the primary reason the Service User needs assistance from us?*

PLEASE NOTE: The option for “Low Income/Wages” is for those who either are employed but their wages do not meet their general outgoings, or for parents who have an income but are not able to work due to childcare. Any other circumstance must be appropriately selected in this list.

Has the Service User been referred to us before?*

What was their previous referral number?*

Additional Details*

Please tell us how you reached a decision to refer this service user. You must tell us in more detail as to why the service user needs support from us. This is so that we can look to provide ongoing support for them, and to ensure our help is going to those most in need.

We do not accept “N/A” as an appropriate response, or simple sentences that reiterate that someone is in need. Referrals will not be accepted if this type of response is used in the field below.

Service User Details

Please ensure that these details are filled in accurately. Thank you.

Name*

Telephone Number*

Address*

Postcode*

Email address*

If the Service User does not have an email address, please use your email address.

Confirm Email address*

Number of Adults in household?*

Number of Children in household?*

Once the referral has been submitted the following will happen:

You will receive a confirmation email that your referral has been submitted.
The Service User will have access to ongoing support from us until the expiry date of the referral number
Within the next 10 minutes a referral number will be generated. This will be emailed directly to the Service User if you gave us their email address, or it will be emailed to you if you didn’t provide an email address for the Service User. If you receive the referral number, you must pass this on to the Service User. Without it, they will not be able to get help from us.

IMPORTANT:

The Service User must contact us each week to request help by using our website or our telephone support service. As soon as their referral number is received, they are able to start making their requests.

By submitting this request form, you are declaring that you have told the Service User how our system works, and that they agree to us holding their information in accordance with our Privacy Policy, and that we may use it to provide a service to them. You are also agreeing that we can hold the information you have submitted about yourself on our files.

Referral Expiry Date

This field should be left blank

CARE Support Request Form

Temporary Assistance Request

Your Details

Your Request

Your Request: A Telephone Call

Referred Assistance Request

Service User Details

Your Request: Essentials Food Parcel

Your Request: A Telephone Call

Referral Form

Important information from July 2022

Referrer Details

Eligibility

Service User Details

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