About your circumstances (Page 1 of 3)

There are three parts to this form. Part 1 is about you and your circumstances, Part 2 is about your finances, and Part 3 is about your employment. Due to the automatic processing of these applications, some applicants will only be shown the first two pages - we still consider these applications and will ask you for more information where necessary. You do not need to resubmit your application. You can read how we use your data at: https://twinstrust.org/let-us-help/support/helping-hands/helping-hands-privacy-policy.html
Important information regarding all new applications
We are continuing to monitor the rapidly evolving public health situation around COVID-19, the new coronavirus. We are reflecting on the guidance provided by Public Health England and in light of this we have reviewed the practical support we provide to families who have applied for support from Helping Hands. The health and wellbeing of families and our support practitioners is extremely important to us therefore, we have taken the decision to postpone all practical at home support given to families at this time.

We will be supporting all families who are currently being helped, along with all new eligible applications with remote support. This may take the form of phone calls, video calls such as Facetime, WhatsApp video call or Skype, a Twins Trust webinar or one of our many other online resources.

We appreciate everybody’s understanding regarding the situation and we’ll keep working with both families and the practitioners to deliver the support that our families need. Here’s the latest government guidance on the virus https://www.gov.uk/government/topical-events/coronavirus-covid-19-uk-government-response

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* 1. Main carer's name and date of birth

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* 2. Partner's name and date of birth (if applicable)

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* 3. Name of the person who is completing this form (if different from above)

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* 4. Role of the person completing this form

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* 5. Your current address

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* 6. Your best contact number(s)

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* 7. An alternative name and phone number, such as a partner or family member.

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* 8. Your best email address

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* 9. What is your ethnic group?
Please choose one option that best describes your ethnic group or background.

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* 10. About your family.
Please tick which applies:

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* 11. Names, sex and date of birth of multiples

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* 12. At how many weeks' gestation were they born?

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* 13. Do you have any other children?

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* 14. Is there an urgent medical need for yourself, your partner or any of your multiple birth children? If yes please give details below.

All applications must be supported by a health professional, such as those listed below, who has visited you at home on at least one occasion. We do not accept supporting statements from a GP. Where available we also require an email address and/or direct number for your health professional.

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* 15. Job role of the health professional who is supporting your application

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* 16. Name and phone number of the health professional who is supporting your application.

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* 17. Email address of the health professional who is supporting the application

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* 18. Helping Hands categorise cases and prioritises those who are in crisis and immediate need. From the options below please tick the box or boxes you feel best describes your family and the need for support.

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* 19. Please explain why your family is applying for help and what would help your family cope better.
Please note that Helping Hands offers very short term support with multiple-specific challenges and cannot provide regular or long-term help. Helping Hands is not a childcare service and works with parents to address the difficulties they are experiencing.

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* 20. Please rate below where your family is most in need of support.

1 - Being no problem at all.
5- Being I am struggling to cope, it is impacting on family life.

  1 2 3 4 5
Behaviour
Feeding/Weaning
Establishing Routines
Getting Out and About
Sleep Patterns
Other, please specify below

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* 21. How stressful is the situation for your family?
1- Being I am not stressed at all.
5- Being I am extremely stressed.

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* 22. Do you have any practical help at home from friends and family?

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* 23. Do you pay for any of the following support?

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