Apply to The Good Fund For Help
PLEASE FILL OUT ONE APPLICATION PER PERSON NEEDING HELP
Applicant Email *
Your answer
*** NOTE ABOUT EMAIL ADDRESSES
Due to the high security on ICLOUD and ME email accounts we cannot send emails through to you, they bounce back. Please use an alternative email address.
First Name *
This must be the name of the person you are applying for (either yourself or someone else)
Your answer
Last Name *
This must be the name of the person you are applying for (either yourself or someone else)
Your answer
Caregiver First and Last Name
If you are applying for a child or someone else please type your First and Last name here
Your answer
Phone Number *
Phone number is now required - we need this to be able to call you if we think we need to get more detail to get the right products for your body type.
Your answer
Ethnicity *
This information is optional. Please tick "I prefer not to provide this information" if you do not wish to answer this question.
Iwi
This information is optional but could help other people in your area that may need a fully funded menstrual pack.
The Age of the person we are helping *
Which Region are you from? *
Tell us how The Good Fund can help you (your story) *
Your answer
I am applying: *
Required
What menstrual products do you currently use *
You can select more than one option
Required
What sort of reusable menstrual products are you interested in? *
You can select more than one.
Required
Have you experienced any of the following?
You can select more than one option
Do you experience any of the following:
You can select more than one option.
Do you have a Community Services Card?
Are you WINZ client?
Permission *
Please select one. Your story can encourage others to seek help from The Good Fund
I understand that the data I have provided will be used for anonymous data reporting for The Good Fund *
Submit
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