Eligibility Form | TheMaynardFoundation

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Completing this Eligibility Form is an important step in applying for food support from The Manna Project. Your answers help us understand your circumstances and assess how we can best support you.

Maynard Foundation Resource Form

Help us make a difference

Name

Age

Email

Contact #

How much is your current income?

How many people are in your household?

How many adults (18+) live in your household?

How many children/dependants under 18 live in your household?

How many people in your household are financially dependent on the household income?

Which sources of income does your household currently receive?

Employment/self-employment

Universal Credit

Pension

Child maintenance/support

Other regular income

No regular income

If other, please specify:

Rent or mortgage

Council Tax

Gas/electricity

Water

Essential travel costs

Childcare/caring costs

Essential debt repayments

Other essential household costs

If you have included other essential costs, please briefly describe them:

“How much money is left each month after essential costs?”

CHANGES IN YOUR FINANCIAL CIRCUMSTANCES

Loss of employment

Reduction in working hours or income

Benefit delay, reduction or change

Increase in rent or housing costs

Temporary financial emergency

Other

If you selected other, please let us knowyour circumstances

Who were you Referred by ?

Does anyone in your household have any food allergies or dietary requirements that we need to know about?

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