Application for Assistance

Your information is confidential and will be reviewed with care and respect.

Your Details

Optional if phone provided

Optional if email provided

Your Address

Your full address is confidential and visible only to our team. Your postcode is used for anonymous reporting to understand where support is needed.

Tell Us How We Can Help

Select the category that best describes your need

Please share what support would help you most. Be as specific as you're comfortable with.

Optional - if you have a specific amount in mind

Before You Submit

  • Our team will carefully review your application
  • We'll contact you using the details you provided
  • Your information remains completely confidential
  • Submitting this form does not guarantee assistance, but we'll do our best to help
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