Winchester Food & Basics Bank Collection Request Form Email(Required) To apply you need to live within Winchester City area, surrounding Parishes or Alresford.(Required) I confirm that I live within Winchester city, surrounding areas or Alresford. I live outside the area, but have been told to apply (give details below) If you live outside of our area, who has referred you to our services?SELF-REFERRAL DEADLINE Self-referral requests must be submitted by 10.30 am to ensure they are dealt with on the same day. We are a small team, working specific hours, so please bear with us if we do not respond on the same day. Please wait for our email confirming that your application has been accepted (not just the auto-response) before attending one of the hubs.Consent(Required) I understand I am only allowed 4 self referrals. I may have further access to the Winchester Food & Basics Bank for emergency food via agencies. See the WFBB Fair Use Policy for more information.WFBB Fair Use Policy.How many adults are you requesting food for?(Required)Please enter a number from 1 to 5.An adult is considered anyone 18 and over, including teenagers still in full-time education.How many children are you requesting food for?(Required)Please enter a number from 0 to 10.From 1 years of age to 17 years old. We do not have food for babies but can supply nappies.Adult 1(Required) First Last Adult 1 DOB(Required)DayDay12345678910111213141516171819202122232425262728293031MonthMonth123456789101112YearYear202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Adult 1 Employment Status (select one)(Required) Unemployed / Benefits Part-time employed Full-time employed Retired Short Term Illness Long Term Illness Student Full Time Carer Refugee (with permission to work) Asylum Seeker (awaiting permission to work) Prefer not to say Address(Required) Street Address Address Line 2 City ZIP / Postal Code Adult 2(Required) First Last Adult 2 DOB(Required)DayDay12345678910111213141516171819202122232425262728293031MonthMonth123456789101112YearYear202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Adult 2 Employment Status (select one)(Required) Unemployed / Benefits Part-time employed Full-time employed Retired Short Term Illness Long Term Illness Student Full Time Carer Refugee (with permission to work) Asylum Seeker (awaiting permission to work) Prefer not to say Adult 3(Required) First Last Adult 3 DOB(Required)DayDay12345678910111213141516171819202122232425262728293031MonthMonth123456789101112YearYear202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Adult 3 Employment Status (select one)(Required) Unemployed / Benefits Part-time employed Full-time employed Retired Short Term Illness Long Term Illness Student Full Time Carer Refugee (with permission to work) Asylum Seeker (awaiting permission to work) Prefer not to say Adult 4(Required) First Last Adult 4 DOB(Required)DayDay12345678910111213141516171819202122232425262728293031MonthMonth123456789101112YearYear202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Adult 4 Employment Status (select one)(Required) Unemployed / Benefits Part-time employed Full-time employed Retired Short Term Illness Long Term Illness Student Full Time Carer Refugee (with permission to work) Asylum Seeker (awaiting permission to work) Prefer not to say Adult 5(Required) First Last Adult 5 DOB(Required)DayDay12345678910111213141516171819202122232425262728293031MonthMonth123456789101112YearYear202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Adult 5 Employment Status (select one)(Required) Unemployed / Benefits Part-time employed Full-time employed Retired Short Term Illness Long Term Illness Student Full Time Carer Refugee (with permission to work) Asylum Seeker (awaiting permission to work) Prefer not to say Child 1(Required) Toddler: 1 to 3 years old Pre-school: 3 to 5 years old School-Age: 5 to 12 years old Secondary School-Age: 13 to 17 years old Prefer not to say Child 2(Required) Toddler: 1 to 3 years old Pre-school: 3 to 5 years old School-Age: 5 to 12 years old Secondary School-Age: 13 to 17 years old Prefer not to say Child 3(Required) Toddler: 1 to 3 years old Pre-school: 3 to 5 years old School-Age: 5 to 12 years old Secondary School-Age: 13 to 17 years old Prefer not to say Child 4(Required) Toddler: 1 to 3 years old Pre-school: 3 to 5 years old School-Age: 5 to 12 years old Secondary School-Age: 13 to 17 years old Prefer not to say Child 5(Required) Toddler: 1 to 3 years old Pre-school: 3 to 5 years old School-Age: 5 to 12 years old Secondary School-Age: 13 to 17 years old Prefer not to say Child 6(Required) Toddler: 1 to 3 years old Pre-school: 3 to 5 years old School-Age: 5 to 12 years old Secondary School-Age: 13 to 17 years old Prefer not to say Child 7(Required) Toddler: 1 to 3 years old Pre-school: 3 to 5 years old School-Age: 5 to 12 years old Secondary School-Age: 13 to 17 years old Prefer not to say Child 8(Required) Toddler: 1 to 3 years old Pre-school: 3 to 5 years old School-Age: 5 to 12 years old Secondary School-Age: 13 to 17 years old Prefer not to say CLOTHING If you need clothes, adult clothes are available from our Highcliffe Hub (Milland Road site) no additional appointment necessary, however if you need to collect adult or children’s clothes from the Vineyard Church, you must make an appointment via 01962 863217 or email storehouse@winchestervineyard.org . Vineyard Storehouse. PLEASE READ Once you’ve pressed submit, your request will be reviewed and you will receive a response to confirm we have accepted your request, or to request further information. Please check your SPAM/JUNK folder – if you have not received a response within 48 hours (Mon-Fri) please email referrals@winchesterbasicsbank.co.uk or ring 01962 864720. DO NOT visit the hub until you have received the confirmation email.Consent(Required) I consent to my data be stored by Winchester Food & Basics BankCollecting information is important as it helps us identify and address how we can better support you through our services. We do not share your data with third parties, nor do we sell data. By ticking the consent box, you agree to Winchester Food & Basics Bank processing yours and your household’s data in accordance with the Data Protection Act 2018, the UK GDPR, and any other data protection legislation.Please read our Privacy Notice WFBB Data Privacy Notice Clients.