Adult Carer Wellbeing Fund Application Form

Before applying, please ensure that you have read through our Carer Wellbeing Fund guidelines before making your application.

If the grant is successful, we shall transfer the funds directly into your bank account. This could take up to 30 days once approved to reach your bank account.

Name(Required)

First Name Last Name

Email Address

Phone Number(Required)

What benefits are you currently in receipt of that complies with our eligibility criteria?(Required)

Please upload evidence of this benefit here (Screenshots, forms etc.)(Required)

Max. file size: 512 MB.

Has you received funds from the Carer Wellbeing Grant before?(Required)

Yes

When did you last recieve funds from the Carer Wellbeing Grant?

How many times have you received funds from the Carer Wellbeing Grant?

How many hours per week do you spend caring?(Required)

What are you applying for?(Required)

Please provide additional details such as make, model, colour, size, etc.(Required)

What store or website is this available from?(Required)

Please include the link from the website into the application so that we know exactly what it is you’d like to purchase.

How much will this cost? (£)(Required)

How will you pay the difference if the full price is not granted?(Required)

How will having this item benefit you?(Required)