Our application form for Stage 2 includes these sections:
Section 1: The type of support you are applying for (regular payment and/or one off grant) and details of any agency supporting you in your application.
Section 2: Contact details; previous occupation; marital status.
Section 3: Personal details including: household composition/contributions.
Section 4: Details of One Off Grant Requests.
Section 5: Financial Information (Income and Expenditure).
Section 6: Further Information – for you to explain their circumstances and reason for application.
Section 7: Declaration that the information you have provided is accurate.
What Information do you need to complete the Application Form?
To complete our application form you will need to have the following information available:
Your income including:
- Current state pension, pension credit;
- Other state benefits: PIP, Income Support, ESA;
- State/private or occupational pension(s);
- Bank/building society interest;
- Other income from family/relatives;
Your Household expenditure:
- Rent/mortgage interest
- Council tax
- Water rates
- Nursing or residential home fees (as applicable)
Any capital you may have:
- Savings you may have in bank or building society account
- Details of other savings
- Details of any shareholdings
Additional information we require at Stage 2
- If you are applying for a one-off grant, we will also need a headline estimate about the equipment/building work required, and (if available) a copy of any professional assessment outlining your requirement for the equipment/aid/adaptation you are seeking to purchase or make. This may include an occupational therapist or social work assessment.
- We also ask for the details of any advice/support agency working with you in applying to us and ask for a supporting letter where applicable from them (e.g. Raise; Jubilee Debt Advice; Citizens Advice Bureau; housing association money advice officer).
Download your application form
Please click the link below to download your form so you can start Stage 2 of your application.