Applying for a grant award from the Honeypot Wellbeing Fund funded by the Hampshire Household Support community grants scheme 2025.

Have you received any vouchers through other organisations across Hampshire? *

Yes

No

Name of Parent/Guardian 1 *

First Name

Last Name

Name of the Child *

First Name

Last Name

Date of birth *

MM

DD

YYYY

Do any of the following family characteristics apply to this child? Tick all that apply *

Single parent/guardian household

Keyworker parent/guardian

Military parent/guardian

No parent/guardian employment

Parent/guardian in prison

None of the above

For whom does the child care? Tick all that apply *

Mother/Step-Mother

Father/Step-Father

Sibling

Grandparent

Other

Not a Young Carer

Which of the following caring tasks are undertaken by the child? Tick all that apply *

Cooking/meal preparation

Cleaning/housekeeping

Laundry

Shopping

Assisting with household finances/bills

Assisting with eating/drinking

Assisting with medication/appointments

Assisting with dressing

Assisting with bathroom (washing/bathing/toilet)

Interpreting/explaining

Physical support/assistance

Emotional support

Looking after siblings

Not a Young Carer

Which of the following eligibility criteria apply to the child? Tick all that apply. *

A) A sibling or parent living with the child is in receipt of Carer's Allowance

B) A sibling or parent living with the child is in receipt of a Personal Independence Payment (PIP)

C) A sibling or parent living with the child is in receipt of Disability Living Allowance (for Adult or for Child)

D) A sibling or parent living with the child is in receipt of Employment and Support Allowance