The Sequal Trust Membership Application Form

Are you a British citizen?(Required)

I confirm I am a British Citizen.

If born outside the U.K. please provide details and proof of citizenship.

(documentation required)

How did you learn of our service?(Required)

Name(Required)

Title Christian Names Surname

Date of Birth(Required)

Your address (Parental or Residential Home if applicable)(Required)

Street Address Address Line 2 City County Postcode Country

Disability details. (In cases of Autism or Learning Difficulties, please provide Statement):(Required)

Tel No:(Required)

Name & email address of parent/guardian(Required)

Employment details of parents, if applicable, even if not living at home.(Required)

Have you or anyone on whom you are dependent, been a member of the Armed Forces/a professional or administrative body/Union? Please give Union/Service number; details of where and when stationed, together with dates of term served.(Required)

Your past employment history, if applicable:(Required)

Details of your hobbies/pastimes/goals/achievements/dislikes etc:(Required)

Description of your home life e.g. strong support network in care home; lives at home; family details even if not living at(Required)

Description of applicant’s personality e.g. happy, bright, logical, caring, sensitive, down-hearted, emotional, loving, shy etc.(Required)

Any other relevant notes or points of interest about applicant’s life including details of accident, stroke etc. if applicable. church attended/other contacts you think may make a donation.(Required)

Signed(Required)

Today's Date(Required)

In signing this form you are agreeing to the conditions of application as given below:

I have read, understand and agree to the above requirements for membership.

Privacy notice in accordance with GDPR rules:

The Sequal Trust is a national charity which fundraises to provide communication aids for it’s disabled members who do not have sufficient income to purchase such devices themselves. Life membership covers life long equipment loan and technical maintenance of any issued equipment. Sequal operates by applying to fund giving organisations and charities, both local and national, for monetary donations towards the cost of the equipment recommended for your needs. This could include Lions, Rotary and Round Table Clubs as well as local media contacts, shops and businesses. In doing so, we may be asked to divulge such details as are included on these forms. However, we will never divulge contact details or further information to a prospective funder without first gaining your permission. All information provided is kept on a secure database and in hard copy form until such a time as it is no longer needed, at which point it will be deleted.

Please note:

We are not able to supply devices on demand or give a definite waiting time whilst the fund raising campaigns are conducted – this could take from a few weeks to a maximum of 4-6 months depending on the cost of the required device.
Sequal retains ownership of all equipment which is issued on a life long loan basis. Once supplied, although we remain responsible for all technical repairs and necessary replacements, NOT caused by the user, you are required to insure the equipment against loss, theft or accidental damage.
Where computers or laptops have been provided, attempts to access the hard drive will invalidate the warranty. Broadband contracts or resulting problems are not covered in our remit. However, advice on all these issues are available from our office during opening hours.
Letters of thanks and photos sent in to The Sequal Trust at any time, which are felt to be of interest to other members or prospective donors, may be included in our publications or on our website using only Christian names.
The applicant or their guardian if a minor, will be responsible for all programs and files downloaded and contained on computer equipment issued to you by The Sequal Trust. Some internet sites contain material of a strictly adult nature and we would request access to be rigorously monitored.
Any computer equipment is issued to the member and not intended for use by family members or friends.
Please note that proof of UK citizenship is required. Acceptable documents include a valid UK passport, driving licence, or a birth certificate indicating UK citizenship.

As the purpose of The Sequal Trust is to provide vital communication equipment to those individuals who are either solely in receipt of benefits/allowances or their disposable income is low even if they are in employment, you are required to complete the accompanying income and expenditure form as pertains to your household situation. This information may also be requested and supplied to prospective donors who ask for the completion of their own and more detailed application forms