New Carers Funds Application
PLEASE NOTE THIS APPLICATION FORM MUST BE SUBMITTED ONLY BY STAFF MEMBERS OF CARER SERVICES THAT ARE PART OF THE CARERS TRUST NETWORK.
If you are a carer and would like to apply for a grant, you can contact your local carer service and speak to a Support Worker there about your caring role and your need for a grant and they may be able to help you. You can find your local carer service on this page of the Carers Trust website: https://carers.org/help-for-carers/carer-services-near-you. Please do not submit this application directly to Carers Trust as we will not be able to process it.
Guidance for Carers Trust Network Partner staff
Before completing this application, please ensure you have read the online application guidance: Online Application Guidance
This guidance contains a step by step guide to completing the online application form, Carers Funds Guidance Notes and a Word version of the application form which contains the Carer Declaration Form which provides consent from the carer and other referenced adults for this information to be shared. Please ensure you have saved the information you plan to submit in this online application in this Word version of the form - Carers Trust will not be able to send copies of this information once it has been submitted.
Section 1: Contact Details
Network Partner contact name*
Date of birth (DD/MM/YYYY)*
Section 2: Details of Caring Situation.
What are you applying for?*
How many hours a week (in total) do you spend caring?
Please complete a separate section about each person (max 4) you provide care to.
The person I provide care to*
Date of Birth of person I provide care to (DD/MM/YYYY)*
What condition is the person I provide care for affected by?*
What is the nature of care you provide? (please tick all boxes that apply)
The person I provide care to
Date of Birth of person I provide care to (DD/MM/YYYY
What condition is the person I provide care for affected by?
What is the nature of care you provide? (please tick all boxes that apply)
The person I provide care to
Date of Birth of person I provide care to (DD/MM/YYYY
What condition is the person I provide care for affected by?
What is the nature of care you provide? (please tick all that apply)
The person I provide care to
Date of Birth of person I provide care to (DD/MM/YYYY
What condition is the person I provide care for affected by?
What is the nature of care you provide? (please tick all that apply)
Section 3: Information about the request
What type of break are you applying for?*
If you have selected ‘Other’ from the list above please provide a short description of what is being requested
Please give details of the break (where you would like to go, who with, and when). *
If the request is for an activity that will take place away from the person you care for, who will provide this care while you are away?
What difference will this make to your life and how will it help you in your caring role? (this may be practical help, help for you emotionally or a benefit for the person you care for)*
Section 3: Information about the request
What type of transport request will the grant be used for?*
If you have selected ‘Other’ from the list above please provide a short description of what is being requested
Please give us more details about the request (e.g. what type of transport is needed)*
If the request is for an activity that will take place away from the person you care for, who will provide this care while you are away?
What difference will this make to your life and how will it help you in your caring role? (this may be practical help, help for you emotionally or a benefit for the person you care for)*
Section 3: Information about the request
What type of item are you applying for*
If you have selected ‘Other’ from the list above please provide a short description of what is being requested
Please give us some more details on why this item is needed, in particular we would like to know whether you already own this item and if so, why you need this new item (e.g. the item you currently have is broken)*
What difference will this make to your life and how will it help you in your caring role? (this may be practical help, help for you emotionally or a benefit for the person you care for)*
Section 3: Information about the request
What will the grant be used for?*
If you have selected ‘Other’ from the list above please provide a short description of what is being requested
Please give us more details about the request. If the request is for a course or qualification please tell us the name of the course and where it will be taking place (e.g. name of college, online course, etc).*
If the request is for an activity that will take place away from the person you care for, who will provide this care while you are away?*
What difference will this make to your life and how will it help you in your caring role? (this may be practical help, help for you emotionally or a benefit for the person you care for)*
Section 3: Information about the request
What type of item are you applying for?
If you have selected ‘Other’ from the list above please provide a short description of what is being requested.
Please use this space to give further details on why this item is needed and if the request is for a particular piece of equipment or software. *
What difference will this make to your life and how will it help you in your caring role? (this may be practical help, help for you emotionally or a benefit for the person you care for)*
Section 4: Cost of request
Total cost of item/ activity*
Total amount requested from Carers Funds*
If the total cost and total amount requested do not match, how will the difference be covered?
Please tick this box to confirm you have seen a quote for the cost of the request e.g. a written quote from the supplier, a web page or a catalogue*
Section 5: Household Financial Information Statement
Total household weekly or monthly income*
Total household weekly or monthly outgoings*
Total amount of accessible savings (£)
If you have any excess household income or accessible savings, please use this space to explain what they are used for and why they cannot be used to pay for the item requested.
Are you in receipt of any of the following benefits? (please tick all that apply)
Are you or the person you care for in receipt of the following benefits?
Section 6: Declaration and Consent
In order to submit an online application to Carers Funds you must have obtained the signatures of the carer and any other adult referenced in the application form (if applicable) on the Carer Declaration form. You can find this form by clicking on the ‘Application Guidance notes’ link on the first page of this online form. You do not need to send the signed form to us. Please tick the box below to confirm that this form has been signed and the statements below have been agreed to.
- all information provided is true and accurate;
- all referenced adults consent to the collection, processing, sharing and secure storage of this information by the Carers Trust Network Partner and Carers Trust and;
- all adults consent to providing full information on how the grant has been spent if requested by the Carers Trust Network Partner and/or Carers Trust
I have had sight of signatures from all adults referenced in the application and confirm that the above statements are true.*
Please tick one or both of these boxes if the carer has ticked one or both of the boxes in the ‘Case studies and contact consent’ section of the Carer Declaration form. If neither of these boxes have been ticked by the carer, please leave them blank.
Please tick the box below if you consent to Carers Trust making contact with your Care Support Worker to discuss your sharing your story.
Please tick the below box to provide consent for details of your caring situation to be used in an anonymous case study.
Section 7: Supporting Statement of the Network Partner staff member
How long have you been in contact with the carer and what has been the nature of this contact?*
What is the impact of the caring situation on the carer?*
How do you think the requested item or activity will benefit the carer?*
Are there any other factors you would like the assessors to take into account? E.g. additional caring roles, significant financial difficulties etc. Please also use this section to expand further on any details of the caring role you were not able to cover in Section 2.
All information provided is true and accurate and I consent to providing full information on how the grant has been spent if requested by Carers Trust and/or the applicable funder.*