Application and eligibility form

Application and Eligibility Check Form

Only complete this form if you claim one or more of the benefits listed below. You can also complete this form by contacting York Family Information Service on 01904 554444.

Please complete this form in full for the main benefit claimant. Failure to provide all the information will prevent your application from being processed. Only use full legal names including middle names.

Eligibility
To be eligible you must be claiming one or more of the following benefits or meet one of the other criteria. Please tick all you are claiming. *
 
 
 
 
 
 
 
 
 
 
 
Main Benefit Claimant's Details
Child's Details
Gender *
  
 
 
How did you find out about the funding?
 
 
 
 
 
 
 
 
 
 
 
 
 
 

Family Information Service

01904 554444

fis@york.gov.uk