Mental Health Support Application Form

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STRICTLY PRIVATE & CONFIDENTIAL

To apply for mental health support from the Royal Variety Charity, please complete the following Application Form.

Eligibility

To be eligible to apply for mental health support from the Royal Variety Charity, you must have worked professionally in the entertainment industry for a minimum of 3 years, earning most of your income from the industry.

Requirements

• A CV/Biography detailing your professional work in entertainment, along with supporting evidence.

• Your most recent bank statement(s).

• A photo of your UK passport details page (assistance is available to British citizens only).

If you need help completing this application, please contact mentalhealthsupport@royalvarietycharity.org or telephone 020 8898 8164, ext 210, for assistance. There is no need to use £ signs in the number fields.

First Name

Middle Name

Last Name

Stage or Professional Name

Date of Birth

House number and street

City

Post Code

County

Country

Home Phone

Mobile Phone

I agree that the Royal Variety Charity may contact me by:

Post
Phone
Email

How did you hear about the charity?

Reason for your application and how we can help you

Brief summary of your career within the entertainment profession. Please include dates or length of career.

Date of last professional engagement

Do you have any health issues we should be aware of (please provide details and attach a letter of diagnosis from GP or Hospital)

Have you applied to The Royal Variety Charity before?

NoYes

Have you applied to any other charity or source in respect of this request? (If so please give details)

I agree to receive information on The Royal Variety Charity from time to time

What we do with your information

The Royal Variety Charity will hold your personal data and information about you in writing or electronically in relation to your application for support.

Further details on your rights regarding personal information are available on www.ico.org.uk

Full details of our privacy statement are available on our website www.royalvarietycharity.org

The Royal Variety Charity registered number is 206451

Please be assured that your application is treated in absolute confidence.

Declaration

I confirm that the details that I have given in this application are correct and answered to the best of my ability. I give my permission to the Royal Variety Charity to share this form, in the strictest confidence, with other charities, such as BAPAM, in connection with my application, if deemed appropriate.

I confirm my agreement to the declaration above (please type your name)

Passport Photo/Details page

Bank Statement

Medical Information

General

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