Sheffield Area Kidney Association

Please fill in the form below to enquire about getting financial assistance from SAKA. We will get back to you as soon as possible. If we think we can help we may require more details, or we may signpost you to other sources of help.

If you have difficulty filling in the form, please send an email to:

treasurer@saka.org.uk

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SAKA Enquiry form

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Name: *

Address *

Post Code *

E-mail address: *

Phone No

Date of birth *

To decide if you are eligible for a grant the renal social workers may need details of your income and regular expenditure. Please tick the box to give permission for SAKA to pass on your details to the social work team.

Current treatment e.g. pre dialysis, dialysis, transplant etc. *

Employment status e.g. employed, receiving benefits, retired etc. *

What help do you need? *

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