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Grant application form

Before completing this grant application form, please note the following:

If you have any difficulties completing the form, please get in touch with us. Your answers help us get a picture of your situation and how we can best support you. There are no right or wrong answers, but please complete all sections.

Please note that Carers Link can only support one short break per household per year. We may be able to help in other ways or signpost you to other grants, so please email valerie@carerslink.org.uk and enquire.

1. About you

Name

Address

Postcode

Telephone number(s)

Date of birth

2. About your caring role

If you care for more than one person, please tell us about the person you care for the most, or whose caring causes the most issues. We will then get details of the other person/ other people when we speak to you.

Please tell us about the kind of support and care you provide, and how this affects you.

Does anyone help you in your caring role, e.g. professionals, family members or friends? If so please briefly describe the type of help given.

Do you have any breaks from your caring role at the moment? If so, please describe them.

If you are not already known to Carers Link, please can you give us contact details of someone who can confirm your caring role or who are supporting your application.

3. About the grant

Please tell us about how you would like to use the grant funding

How much would this cost? If you don't know, please estimate the amount

Please note there is a maximum Time to Live grant for each household

How much would you be able to contribute to the cost?

Are there any barriers to you taking this break?

4. Please tell us how many people will benefit from this grant (this is needed for statistical purposes for reporting)

Carers

Cared for person(s)

Siblings (under 5)

Siblings (5 - 18)

Siblings 18 - 25)

Others

Friends. extended family

5. Please tell us which of the following will apply to you if you take your break

Carers and the people they care for will have improved wellbeing

Carers will have more opportunities to enjoy a life outside of their caring role

Carers will feel better supported to sustain their caring role.

6. Your full application will be kept for a period of up to 3 full years from the date received. A summary of the grant purpose will also be confidentially stored within a restricted access database as per the full Privacy Policy. Carers Link are, however, legally required to store records relating to financial transactions for a period of 7 years and a summary of the grant will be kept for this purpose.

Please use the drop down box below to confirm your understanding regarding these retention periods.

7. Consent Form - please read the following carefully.

We need this information so that we comply with General Data Protection Regulations (GDPR). This legislation gives you more rights, and places greater obligations and stricter controls on organisations.

Your consent to store

Full details of how an why we store information can be found in our Privacy Policy at https://carerslink.org.uk/download/privacy-policy-for-carers/. Any updates or changes to the policy are announced via our newsletters.

Please choose from one of the options below

8. Bank details. Please provide details of the account any grant should be paid into. You do not need to provide bank details at this stage, but it will speed up the payment process if you are awarded a grant. Carers Link asks you to send in receipts for proof of purchase. Failure to do this may affect the decision of any future grant application.

Name of bank

Name on the account

Sort code

Account number

Please use the drop down box below to confirm your understanding regarding the provision of receipts

9. Signature. If you are under 16 years of age, we need a signature from your parent/guardian as well

Your signature

You can type your name, you do not need to write it.

Name of parent/ guardian (if applicable)

Signature of parent/ guardian (if applicable)

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