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We’ve put together the following list of possible scenarios to help you complete the form most accurately.
Scenario 1: The person with the disability has lived with you at some point over the last 10 years. If this is the case, please check off ‘Yes’ to question #1 and provide us with the timeframe on the line below.
Scenario 2: The person with the disability has not lived you in the past 10 years. However, you financially assisted them with Food, Clothing or Shelter on a consistent basis. If this is the case, please check off ‘No’ to question #1 and proceed to complete the yellow sections highlighted in the example form on this page. Please complete this form with as much accuracy as possible.
Scenario 3: The person with the disability has lived with you at some point over the last 10 years and you have also financially assisted them on a consistent basis with Food, Clothing or Shelter outside of the years you lived together. If this is the case, please check off ‘Yes’ to question #1 and indicate the years the person with the disability lived with you. Then, proceed to complete the yellow section highlighted in the example form on this page. Please complete this form with as much accuracy as possible.
Note: Remember to fill in your address, telephone number and email in the header. Lastly, be sure to sign, add your telephone number and date of signing at the bottom of the statement. These sections are highlighted in blue in the example form on this page.
To see where and how to complete this form – click the image. A full size form, showing the different areas to be completed, highlighted in yellow, pink and blue will open.