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FIFESHIRE FOUNDATION APPLICATION - APPLICANT SUPPORT PERSON
The Fifeshire Foundation is a Charitable Trust. Our voluntary trustees meet monthly to allocate grants to people living in the Nelson/Tasman region who are in “hardship and/or domestic crisis”. We also give grants to agencies that support local people in crisis.
Applications require two support people listed on the form. Please complete the information below. If you would like to contact us please call the manager 027 334 3374.
We meet on the second Friday of each month, and applications must be in by the 25th of the month before. Our application and meeting dates are on our website.
We’re unable to confirm applications are received.
The application will only be viewed by the Fifeshire Foundation Trustees and Manager. The Trustees and Manager will keep confidential all information regarding applicants and their applications that is transferred verbally, in written and electronic form.
Where further information about the application is required, this will only be with the consent of the applicant, and for the purposes of considering the application.
DATE
*
Group
Support Person
CONSENT
CONSENT
*
Please tick as confirmation that you are acting as a support person for the applicant of the name you enter below. PLEASE NOTE we may not be able proceed with the application unless consent is granted.
APPLICANT'S DETAILS
Applicant's ID Number
*
Applicant's Name
*
First name
Last name
When the applicant submitted their application they will have received an email with this number.
SUPPORT PERSON
Please provide your details below. You must NOT be a family member or a friend of the applicant. You can be a budget adviser, Work & Income staff member, support or social worker, doctor or nurse, minister, employer, lawyer, teacher or principal, or any other support person but NOT a family member or friend.
You may also attach a supporting letter, but this is optional.
SUPPORT PERSON DETAILS - You need at least two people to support your application
Support person's name
*
First name
Last name
Organisation
Please Select
APM Workcare
Christians Against Poverty CAP
Employable
Family Works
Family Start
Gateway Trust
Golden Bay Workcentre Trust
Male Room Inc.
Mohua Social Services
Motueka Community House
Motueka Family Service Centre (MFSC)
Nelson Budget Service
Nelson FASD Support Group
Nelson Mental Health
NMDHB
Perinatal Support Nelson
Presbyterian Support Upper South Island
Strengthening Families
The Salvation Army
Te Awhina Marae (Tasman)
Te Korowai Trust
Te Piki Oranga (TPO)
Te Whare Mahana Trust
Volunteer Nelson
Whakatu Marae (Nelson)
Women’s House
Women’s Refuge
Womens Support Link
Work and Income
Young Parent School
Other
Support person's email address
*
Support person's phone
*
Other phone (Optional)
Support person's address
If you are from a support or other agency please provide these address details eg C/- MSD Work and Income Richmond Office 275/279 Queen St P O Box Richmond
Support person's relationship to applicant
*
Select one:
Budget adviser
Case Worker
Doctor
Employer
Family/Whanau Worker
Lawyer
Minister
Nurse
Principal
Social worker
Support Worker
Teacher
Work & Income
Youth Worker
Other
I confirm I have read the completed application form and I support this application.
*
+ Add another
- Remove
The applicant must also provide a completed budget from an approved agency such as Nelson Budget Services Ph 03 546 9021, Te Korowai Trust Stoke Ph 03 547-5958, Te Piki Oranga (for TPO engaged clients) Wakatu and Richmond Ph 03 543 7016, Motueka Family Service Centre Ph 03 528 0234, Mohua Social Services Takaka Ph 03 525 9728. If the applicant is unable to provide a budget, they will have stated this on their original application.
Please check the highlighted fields
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