ALERT Direct Referal
Name
Your answer
Adress
Your answer
Telephone No. *
Your answer
What furniture or household goods do you need?
Your answer
If you have a support or social worker please provide contact details
Your answer
Are you
If you are unemployed, how long have you been unemployed for?
Your answer
Can you please tell us about your situation
We don't want to pry, but we need to understand what has led you to require assistance. As a CIC we have to apply for funding and to get funding we must keep data on the reasons ALERT is needed. All information provided is confidential
Your answer
Are you receiving benefit? If so please tell us which benefits
Your answer
Are you
Do you feel lonely? *
Do you feel part of the community?
What difference will having furniture make to your life? *
We give furniture no matter what. There is no right or wrong answer to this. As much as we don't want to pry we do need to understand why ALERT is needed and what if any difference it will make to people's lives
Your answer
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