Carers Trust Grant Application

to be completed by a carer wishing to apply for a grant

Carers Trust Grant Application

"*" indicates required fields

About Carers Funds

Carers Funds is open to carers aged 16 and over. Carers can apply for grants of up to £400 for items or activities that will benefit them in their caring role e.g.:

Breaks for carers, with or without the person they care for.
Items for the home including cookers, fridges, beds, washing machines etc.
Driving lessons and other travel costs relating to caring roles.
Courses and materials to develop carers skills and personal development
Home repairs
Short term or time limited replacement care

This list does not represent everything Carers Trust will consider; we will accept applications for other requests that clearly describe how they will benefit carers in their caring roles and/ or improve their independence and quality of life.

The following costs will not be funded from Carers Funds:

General living expenses and running costs e.g. rent, food, bill payments and insurance
Debt repayments
Costs of regular, long term replacement care
Specialised equipment e.g. wheelchairs
Home adaptations
Computer and mobile phone equipment.
Requests where the item has already been paid for or a deposit placed (retrospective)

Please note that this grant is processed outside of Barnet Carers, with several stages including a review panel. It can take several months to administer and unfortunately Barnet Carers have no control over the length of time grants may take to process. You will be contacted about the outcome of any grant applications when the decision has been made.

If you have not had a carers needs assessment completed in the last 12 months, please consider completing one as this will help us to provide as much supporting information as possible with your grant application. You can complete this online here: Online Carers Assessment - Barnet Carers

Or book a telephone appointment Carers Needs Assessment here: Book your Adult Carers Needs Assessment - Barnet Carers. This appointment takes approximately 30-60 minutes.

You will then also receive a personalised support plan, completed by a member of the adult carers team.

Carer's Name*

Carer's Date of Birth*

Carer's ID Number*

This number was sent to you when registered as a carer.

Have you had a Carers Needs Assessment in the last 12 months?*

Yes

Please enter your postcode below and click on the Lookup Postcode button

Carer's Address*

City*

Postcode*

Carer's Email

What are you applying for?*

How many hours a week (in total) do you spend caring?*

How many people do you care for?*

Details of Person Being Cared For #1

The person I provide care to is: PBCF #1*

Date of Birth - PBCF #1*

What condition is the person you provide care for affected by? PBCF #1*

Details of condition - PBCF #1*

Please provide details such as their condition/diagnosis and how this impacts them.*

What is the nature of care you provide? PBCF #1*

Details of Person Being Cared For #2

The person I provide care to is: PBCF #2*

Date of Birth - PBCF #2*

What condition is the person you provide care for affected by? PBCF #2*

Details of condition - PBCF #2

Please provide details such as their condition/diagnosis and how this impacts them.*

What is the nature of care you provide? PBCF #2*

Details of Person Being Cared For #3

The person I provide care to is: PBCF #3*

Date of Birth - PBCF #3*

What condition is the person you provide care for affected by? PBCF #3*

Details of condition - PBCF #3*

Please provide details such as their condition/diagnosis and how this impacts them.*

What is the nature of care you provide? PBCF #3*

Details of Person Being Cared For #4

The person I provide care to is: PBCF #4*

Date of Birth - PBCF #4*

What condition is the person you provide care for affected by? PBCF #4*

Details of condition - PBCF #4*

Please provide details such as their condition/diagnosis and how this impacts them.*

What is the nature of care you provide? PBCF #4*

Breaks Application Details

What type of break are you applying for?*

If you have selected Other from the list, please provide a short description or what is being requested*

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?*

Household Item Application Details

What type of household item are you applying for (please tick)?*

Other, please give details:

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).*

Training Application Details

What type of training will the grant be used for (please tick)?*

Course

Equipment

Qualification

Skills and Development

Other

Other, please give details:*

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?*

Transport Application Details

What type of transport request will the grant be used for (please tick)?*

Driving lessons and tests

Transport for education

Transport for leisure

Transport for hospital

Other

Other, please give details:*

If the request is for driving lessons please confirm that you have access to a car, the hourly rate of the lessons, which tests (if any) you are applying for, and how you intend to cover the running costs associated with driving, in particular insurance, fuel and required maintenance.*

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: break, household item, course/ skill or transport request 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)*

Cost of Request

Please note: A quote for the cost of the request e.g. a written quote from the supplier, a web page or a catalogue will need to be provided to the Network Partner.

Total cost of the request - £*

Total amount requested from Carers Funds (maximum £400) - £*

If the total cost and total amount requested do not match, please state how the difference will be covered*

Please upload a written quote from the supplier, a web page or a catalogue will need to be provided to the Network Partner.*

Drop files here or

Max. file size: 128 MB.

Should you need guidance in taking a screenshot, please watch this YouTube video How to Take a Screenshot on Windows 10

Breakdown of Income and Expenditure

Is your household income weekly or monthly*

Weekly

Monthly

Income Examples: Earnings from employment; Benefits; Pension; Direct payments from social care

Employment Income - £*

if Not Applicable, please enter the number zero

Pension - £*

if Not Applicable, please enter the number zero

Benefits - £*

if Not Applicable, please enter the number zero

Tax Credits - £*

if Not Applicable, please enter the number zero

Direct Payments - £*

if Not Applicable, please enter the number zero

Income from Property Rental - £*

if Not Applicable, please enter the number zero

Total household weekly or monthly income - £*

Is your household expenditure weekly or monthly*

Weekly

Monthly

Outgoings Examples: Rent/mortgage; Utility bills (gas, electric, phone, water); Food; Travel; Care costs

Utilities - £ (including broadband)*

if Not Applicable, please enter the number zero

Rent or Mortgage Payments- £*

if Not Applicable, please enter the number zero

Council Tax- £*

if Not Applicable, please enter the number zero

Groceries- £*

if Not Applicable, please enter the number zero

Travel Costs- £ (bus fares, petrol, car insurance)*

if Not Applicable, please enter the number zero

Care Costs- £ (child care, home care)*

if Not Applicable, please enter the number zero

Total household weekly or monthly expenditure - £*

Total Earnings after Expenditure*

Calculation based on figures above

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.*

Household Financial Information Statement

Are you in receipt of any of the following benefits? (please tick all that apply)*

Income Support

Attendance Allowance

Universal Credit

Pension Credit

Employment Support Allowance

Carer's Allowance

Are you or the person you care for in receipt of the following benefits?*

Disability Living Allowance (DLA)

Personal Independence Payment (PIP)

Carers Funds Declaration

In completing and submitting this form, you are confirming that:

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.

Case Studies and Contact Consent

Hearing about the experience of others can encourage more carers to obtain support, raise awareness of carers issues across the UK and enables Carers Trust to raise funds for its work.

Please tick the box below to provide consent for details from this application to be used by Carers Trust within an anonymous story about your caring situation. This may be used in the following ways:

In reports to those who fund our work to demonstrate the impact that caring can have
In our fundraising magazine or other publications
On our websites, Facebook page or Twitter feed
At an event as part of a presentation

We will securely store the anonymous story for five years after which it will be deleted.

Carers Trust Privacy Policy
We promise to keep your personal details safe. You can change how we contact you at any time by contacting us at [email protected] or 0300 772 9600. To see how we protect and use your personal data read our Privacy Policy at Carers.org/privacy-policy.

Carers Trust Grant Application