Individual Grant Application Form

Please fill in all the fields marked *
  • Carers Details

  • Date Format: MM slash DD slash YYYY
  • If yes, please describe. The fact that you work and may not be receiving benefits, or have some savings does not mean we will not help, but we ask you to be open with us about your situation.
  • About the person cared for

  • Date Format: MM slash DD slash YYYY
  • Information about the grant you are applying for

  • Please tell us if your caring responsibilities have impacted upon your physical or mental health etc. If you are applying for a holiday or short break, please tell us where you would like to go? Who would go with you? When and for how long? Is alternative care being provided for the person you care for? Please attach an estimate or quotation where possible.
  • The trustees regret we are unable to reimburse costs already paid or anything that has been booked, contracted for or reserved prior to our agreement to fund/part-fund the cost. Many of the grants we award are under £300 and we may ask you to contribute towards the cost of an item.
  • Professional Endorsement

    Please ask a Social Care/Health Care/ Education Professional or GP Practice to complete this section. We cannot process applications which have not been supported by a suitable professional person. You should not be charged a fee by the professional for this endorsement. Please contact us if this occurs.
  • Yes or No

If you have any difficulties in completing this form or would like to discuss your application, please telephone 01202 698325 or email