Applications can only be made via a 'Support Worker' (an individual acting on behalf of an appropriate agency providing support to applicant's). Application forms must to be signed and come from an official email account.

Examples of who is considered as a 'Support Worker' (and can make an application on your behalf), include: Citizens Advice Bureau, Social Care, Housing Provider/Association, Health Visitor, GP, School, Recognised Membership Group (Guiding/Scouting etc), Locally recognised church/faith Group. These are only examples and you are able to make contact to see if a particular organisation is able to do this.

Applications can be downloaded in 'word' or 'pdf' formats and should be returned by email to It is important that applicants are made aware of the Privacy Notice and complete the Yes/No question in the declaration.

Applications need to be signed by both the Support Worker and the Applicant.

Download 'WORD' application form HERE

Download 'PDF' version HERE  


Download MAP HERE (this is also shown on the application form)

For further information, and to return a completed, please EMAIL the Trustees via


Map showing boundaries of the John Dorkin Charity