Crisis Funeral Grant Fund

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Grant Application Form

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Page 1

PART ONE: APPLICANT'S PERSONAL INFORMATION
dd/mm/yyyy



Postal Address
PERSONAL INFORMATION

Information gathered in this section will not affect your application.  It is taken for demographic reporting only.  It is not accessible to the assessors considering applications.

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PART 2: CARE SECTOR EMPLOYMENT

This part of the application asks for details of your paid employment in the UK's social care sector. Your work must be involved in or support the provision of care. To be eligible, you must be:


•         Currently employed in the care sector with at least three months service




YOU ARE NOT ELIGIBLE FOR A GRANT IF:

 

  •       You are a registered nurse

  •       You are currently employed by the NHS regardless of amount of years in care

  •       You have been awarded £2,000 in total from us across all grant streams
NEW STARTER GRANT FOR NEW CARE WORKERS IN OXFORDSHIRE AND SOLIHULL
If you are new to the care sector and have been offered employment and have not worked in  the sector before OR have previously worked in the sector but have been unemployed for the last 3 months you may be eligible for a grant to help kick start your employment. Please click 'New to the sector and have been offered employment' and fill in the relevant details. Please note we will need to contact your manager/HR department to confirm your completed your first day of your new employment
Stop

If you have been formally disciplined for patient endangerment, please stop your application and email grants@thecwc.org.uk

Most Recent Care Sector Employment 
dd/mm/yyyy
dd/mm/yyyy

Your new Care Sector Employment 
CONSENT
By filling out this application form and providing an email address for your HR/Manager, you are consenting to us contacting your HR/Manager to confirm that you were present on your first day at work
dd/mm/yyyy

Previous Care Sector Employment 

Page 3

PART 3: HOUSEHOLD INCOME AND SAVINGS

Household Make Up

INCOME

We may request additional information or documentation to support the income list below in order to process your application. Please declare your monthly household income.

MONTHLY EXPENDITURE

SAVINGS

DEBT

Banking Information
Please provide banking details.  This will make it easier for us to pay your grant quickly if you are successful.
Please just enter the numbers without spaces or dashes
Please just enter the numbers without spaces or dashes

Page 4

PART FOUR: CIRCUMSTANCE AND NEED

Please select the following circumstances that you have experienced in the last year that have had significant financial impact.  You may select multiple circumstances.



For each circumstance that you select, please detail when the event occurred and the financial impact.





DESCRIPTION OF NEED

Below are some common costs that we can support:

  • Daily Living
  • Bankruptcy/DRO fees
  • Car Repairs
  • Funeral Costs
  • Health Improvement Aids
  • Home Repairs
  • Household Items
  • Moving Costs
  • Preventing Eviction
  • Travel Expenses
  • Whitegoods
Payments will be made directly to the applicant. 

Second Area of Need

DESCRIPTION OF NEED

Below are some of the costs that we can support:

  • Travel costs incl fuel or travel cards/tickets
  • Childcare costs incl breakfast/after school clubs, nursery fees and childminder fees 
  • Transport costs incl car repairs, MOT costs and driving lessons
  • Uniform/ dress code related costs
  • Training and DBS costs
Please note that our maximum grant amount is £500 although we may award a higher grant in exceptional circumstances. Payments will be made directly to the applicant. 

PART FIVE: SUPPORTING DOCUMENTS

p PLEASE ONLY SUBMIT YOUR APPLICATION IF YOU HAVE ALL SUPPORTING DOCUMENTS READY TO SUBMIT. BY NOT SUBMITTING ALL DOCUMENTS YOU WILL BE DELAYING THE ASSESMENT OF YOUR GRANT

MANDATORY: Proof of your employment history in the care sector (one document)

o   Recent payslip


NEW STARTER GRANT

MANDATORY: If you are applying for a new starter grant please provide one of the following (one document)
o   Confirmation letter from your employer stating your conditional employment 
o   Confirmation email from your employer stating your period of employment
o   Confirmation of leave date if previously employed in the form of an email or letter (must have left previous care role in 3 months or more)



       

     You will need to provide the relevant supporting documents based on the circumstances you selected. If you do not provide any supporting evidence your grant will not be considered:


     
Daily living costs:

  • evidence of increased bills / expenditure (a before and after comparison with energy bills for example, or even groceries);
  • evidence of debts, bills you're struggling to pay or loans;
  • evidence of arrears with rent or bills;
  • credit card balance docs;
  • low bank balance;
  • other evidence of a specific cost (school uniforms, shoes and essential household stuff / repairs etc);
  • evidence of seeking debt advice


Illness or Injury:  Medical confirmation 

o   SSP stating time off work due to health issue.

o   Medical letter confirming the condition.

o   Mobility aids need to be recommended by a medical professional.

o   If you are requesting a grant to pay towards home adaptations due to disability, you must have applied for a Disabled Facilities Grant and have a recent occupational therapist’s letter recommending the adaptations.

       Repair Costs: Two Contractor Quotes

       Preventing Eviction/ rent arrears: Proof of Eviction Proceedings or rent arrears

       Bankruptcy or DRO Requests: Letter from a Debt Advice Specialist

       Moving Costs:  New tenancy agreement

       Domestic Violence: Letter /crime reports

       Funeral Costs:  Funeral bill

New starter grant:

Inv  Invoices/quotes or evidence of costs 

nE

nE

      A letter of support - we may ask for this if we need further evidence for your application - please note this is not necessary at this stage

o   This should be a letter supporting your application from a professional who is aware of your circumstances and can explain what the grant is paying towards and difference the grant will make. The letter must be addressed to the care workers charity.

o   Examples of acceptable sources:  housing support worker, doctor, debt advisor, manager at work or an agency such as the Citizen’s Advice Bureau.

o   The letter should be signed and on headed paper.

o   This letter should NOT be from a friend, family member, or co-worker.

 


If you are unable to upload your documents, please send your supporting documents:

·      By email:  grants@thecwc.org.uk

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PART SIX: OTHER POTENTIAL SOURCES OF HELP

We may be able to identify further help for you from other organisations. Additional occupational benevolent funds are a potential source of financial help.

PART SEVEN: REFERRING SOURCES


PART EIGHT: CARE QUESTIONNAIRE AND EQUALITY AND DIVERSITY MONITORING

This questionnaire is optional and will not be factored into the grant assessment.

 

Information gathered in this section helps CWC increase our understanding about the ways we can improve the services we offer. Your responses will be anonymised.



If you are struggling with debt you can contact Step Change or your local Citizens Advice Bureau for free advice


If you are struggling with your mental health, The Care Workers' Charity offers care workers up to ten free counselling sessions. To apply for the support please click here






PART NINE: CASE STUDY INFORMATION

Case studies are an important way in which we raise awareness of CWC and illustrate the positive impact of our work. It also helps our fundraising efforts, which enables us to grow and help more people. 


 

Participation in the case studies is optional. Your decision will not be factored into CWC’s grant assessment. 

 

PART TEN: CONSENT AND DECLARATION

CONSENTS

Your information will remain confidential and only be held or disclosed to assist with your application. The Care Workers Charity processes personal data in accordance with the General Data Protection Regulation and you have a right to request access and/or erasure of your personal data. Please refer to our Privacy Policy to learn more about how and why we use your information.



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