You are applying to be evaluated for an award from the Household Support Fund scheme

    The criteria for assistance from Dial West Cheshire is as follows:
    - Applicants must reside in Cheshire West and Cheshire
    - A disabled person must live in the household making an application

    You will need to upload evidence of the disability, please have it ready. Normally, correspondence from DWP, GP, health professional, social worker etc. is sufficient

    Please complete the form below, clicking the checkbox as appropriate

    Name of HSF Applicant

    Are you or a member of your household disabled?

    Please tick the evidence you are able to supply confirming you or a member of your household have a disability.

    Please upload evidence of the above (eg copy/photo of letter) here

    Please confirm you have attached your evidence ready for uploading

    Do you or a member of your household suffer from Autism?

    Please upload evidence of the above (eg copy/photo of letter) here

    Please confirm you have attached your evidence ready for uploading

    Are you or a member of your household in receipt of Universal Credit (UC)?

    Please upload evidence of the above (eg copy/photo of journal) here

    Please confirm you have attached your evidence ready for uploading

    Sorry, we are not able to help you with your application. Other partners working with Cheshire West and Chester in the delivery of the Household Support Fund may be able to assist you. Further information may be found at Cheshire West and Chester - Household Support Fund

    style="color:#0000ff;" Sorry we are unable to help you as you are not a resident of Cheshire West and Cheshire.

    Please supply the following information about yourself








    Personal Status

    Are you an existing client of Dial West Cheshire?

    Are you making a request for support from any other organisation?

    What type of support do you need?


    By submitting this form you agree to Dial West Cheshire processing and storing your details in accordance with our privacy notice Privacy & Cookie Notice. In addition, you agree to us checking the information provided and where appropriate making a referral to another partner organisation which might be able to offer help and support. We aim to respond within 10 working days of you submitting this application