HSF 7 stage 2

Oldham Parent Carer Forum supported by POINT are delighted once again to be working alongside Action Together supporting Oldham Council’s Cost-of-Living Household Support offer, for families in Oldham

We want to be able to support as many families as we can and the support offered will be a choice of a voucher for none branded school uniform items/supermarket vouchers or other household items.

Please complete all questions, and as this is a limited offer we will be in touch. To help us manage this process efficiently and avoid delays in issuing vouchers, we kindly ask that families please only apply once, as submitting multiple applications slows down the process for everyone.

Please note: Due to anticipated high demand, priority will be given to families who missed out last time. Before submitting the form, please ensure your contact details are correct. Once you’ve registered, a member of our team will be in touch within 7 working days.

We can not guarantee that by registering we are able to offer support.

Thank you.

1. Please provide parent/carer contact information. *

Name(s) of parent/carer	*
Full adddress including postcode	*
Telephone number	*
Email Address	*

2. Ethnicity

This question requires an answer

	Yes
ASIAN or ASIAN BRITISH BANGLADESHI	ASIAN or ASIAN BRITISH BANGLADESHI Yes
ASIAN or ASIAN BRITISH CHINESE	ASIAN or ASIAN BRITISH CHINESE Yes
ASIAN or ASIAN BRITISH INDIAN	ASIAN or ASIAN BRITISH INDIAN Yes
ASIAN or ASIAN BRITISH JAPANESE	ASIAN or ASIAN BRITISH JAPANESE Yes
ASIAN or ASIAN BRITISH PAKISTANI	ASIAN or ASIAN BRITISH PAKISTANI Yes
ASIAN or ASIAN BRITISH AFRICAN	ASIAN or ASIAN BRITISH AFRICAN Yes
ASIAN or ASIAN BRITISH CARIBBEAN	ASIAN or ASIAN BRITISH CARIBBEAN Yes
ASIAN or ASIAN BRITISH OTHER BACKGROUND	ASIAN or ASIAN BRITISH OTHER BACKGROUND Yes
DO NOT WISH TO DISCLOSE ETHNIC GROUP	DO NOT WISH TO DISCLOSE ETHNIC GROUP Yes
MIXED – OTHER MIXED BACKGROUND	MIXED – OTHER MIXED BACKGROUND Yes
MIXED – WHITE AND ASIAN	MIXED – WHITE AND ASIAN Yes
MIXED – WHITE AND CARIBBEAN	MIXED – WHITE AND CARIBBEAN Yes
NOT STATED	NOT STATED Yes
OTHER ETHNIC GROUP	OTHER ETHNIC GROUP Yes
WHITE BRITISH	WHITE BRITISH Yes
WHITE – EUROPEAN	WHITE – EUROPEAN Yes
WHITE – IRISH	WHITE – IRISH Yes
WHITE – OTHER WHITE BACKGROUND	WHITE – OTHER WHITE BACKGROUND Yes

3. Do you or a member of your family identify with any of the following groups.

*

Households with children
Households with a child/young person or person with disabilities and learning disabilities
Households with older adults
Communities who experience racial inequalities
People unable to claim benefits

4. Please can you tell us the following about your household.

	1	2	3	4	5
No of adults living in your home (please include yourself)	No of adults living in your home (please include yourself) 1	No of adults living in your home (please include yourself) 2	No of adults living in your home (please include yourself) 3	No of adults living in your home (please include yourself) 4	No of adults living in your home (please include yourself) 5
No of elderly living in your home	No of elderly living in your home 1	No of elderly living in your home 2	No of elderly living in your home 3	No of elderly living in your home 4	No of elderly living in your home 5
No of children living in your home with a disability or additional needs	No of children living in your home with a disability or additional needs 1	No of children living in your home with a disability or additional needs 2	No of children living in your home with a disability or additional needs 3	No of children living in your home with a disability or additional needs 4	No of children living in your home with a disability or additional needs 5
No of children living in your home without a disability or additional needs	No of children living in your home without a disability or additional needs 1	No of children living in your home without a disability or additional needs 2	No of children living in your home without a disability or additional needs 3	No of children living in your home without a disability or additional needs 4	No of children living in your home without a disability or additional needs 5

5. Please indicate below the support you are looking for, by selecting one option below:

None branded school uniform items to purchase from a supermarket
Food shopping voucher
Other household items

6. Please confirm if you are willing to provide us with feedback to be used for case studies. *

Yes
No

7. If you are nominating a family, please provide your details below.

Name
Contact telephone number
Email address

Consent statement

Your details will be held in the strictest of confidence by POINT and any case studies will be anonymous.