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Counselling Support – Application & Eligibility Form

Counselling Support – Application & Eligibility Form

Please complete this form to help us determine which of our counselling services is best for you.


Guardian Light Foundation provides free counselling for those who are homeless, at risk, or referred by an agency.


Guardian Light Enterprises Ltd offers affordable and accessible counselling for everyone else.


(This form determines which Tier the applicant belongs to)

Personal Details

Birthday
Day
Month
Year
Multi-line address

Current Situation

Are you currently:
Do you have dependents (children under 18)?
Yes
No

Employment & Income

Employment Status:
Employed Full-Time
Employed Part-Time
Self-Employed
Unemployed
Student
Other
Approximate Annual Household Income (before tax):
£0 – £19,999 → Tier 1 (Foundation – Free)
£20,000 – £34,999 → Tier 2 (Discounted)
£35,000+ → Tier 3 (Standard – Accessible pricing)

Note: (Proof required: 3 months of payslips or bank statements.)

Support Requested

Support Requested
Preferred method of counselling:

Consent & Agreement

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Date
Day
Month
Year
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