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WISE Welfare Meals Application
Complete this form to request food or a cooked meal from the WISE Welfare foodbank. This is only for people who live in the High Wycombe area as we are only a small local charitable trust. This initiative will continue while we have funds.
NB: Your details will only be used by specific individuals within WISE charity who are involved in processing your request, and will not be shared with others outside the group unless you give us consent. WISE is the data controller under GDPR and you may request details held about you from WISE or deletion of your data at any time.
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* Indicates required question
Email
*
Your email
Your Name
*
Your answer
Your address
*
Please provide the address where the food will be delivered; if you are homeless, then give us an address for someone else who can represent you or and address where we can find you with the food delivery
Your answer
Mobile Phone number
*
Phone number of the person who we can contact about your food choices and arranging delivery or pick up.
Your answer
Your food preference?
*
Select up to 2 items from the below, which we could alternate. We may provide an alternative if the item you select is not available. We will try to include a fruit and drink with the meal.
Biryani or other Asian food
Pizza or Chicken burger meal
Spaghetti bolognese or chicken pasta
Vegetarian meal
Food parcel so that I can prepare food
Required
List any allergies
*
Please list any food allergies, eg egg, gluten, nut allergy. State none if you have no allergies.
Your answer
About you?
*
Are you applying for yourself as an individual or as a family
Choose
Individual
Couple with children
Couple without children
Single parent with children
How many children living with you
*
How many children do you have under 19 years of age? This will help us determine how much food to provide
Choose
0
1
2
3
4
5
6
NA
Your current situation
*
Choose
Unemployed
Employed
Student
Running my business but struggling
Homemaker
Retired
Disability/illness
Can you explain why you need support
*
Please provide a reason, eg, no food in the house, high energy bills, etc, as this will increase your chance of receiving help
Your answer
Do you have any medical illness
List any medical conditions, including any mental health issues that play a role in your financial situation
Your answer
List any benefits are you receiving
Please state 'none' if you receive no benefits. You are more likely to receive our help if you are receiving benefits but it is not a requirement.
Your answer
Person we can contact for a reference
Please provide name and telephone number for a person we can contact to confirm your situation and your relationship with them. Alternatively, the name of the person who completed the form on behalf of the person who needs help.
Your answer
Do any of your household have special needs
Do you have any vulnerable household members with special educational needs and disability (SEND)
Yes
No
Clear selection
Would you like to attend a money management course?
This free course can help you understand your money coming in and going out. This could help you understand household finances and get on top of debts.
Choose
Yes
No
Maybe but need more info
Do you want your case shared with another agency?
There may be support available from other charities like One Can if you would like your details shared with them
Yes
No
Only after discussion with me
Clear selection
Ethnicity
How would you describe your identity in terms of race or ethnicity?
Your answer
Anything you want to add
You could explain, for example, if you want vegetarian, halal or gluten free dish or different food items for your children versus food for yourself.
Your answer
Filling the form on behalf of someone?
*
If yes, please write down your name and mobile number. If no, please type "N/A"
Your answer
Pickup or Delivery
*
Please indicate if you can come to masjid to pick up or eat your food or whether you prefer delivery to your house
Pickup from Masjid
Eat with Iftar at masjid
Delivered to my home
Frequency of meals
Please indicate how often you would like the evening meal provided (during Ramadhan). Only up to 1 meal per day is provided for the evening iftaar time. While funds last.
Daily
Once every 2 days
Once a week
Weekends only
Weekdays only
Clear selection
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