Please ensure you have scanned or clear photos of your evidence needed to proceed with your application. By clicking the following link, a pop up window will appear. To close the window, click on the X in the top right corner and you will return to this page. Please click here to see a list of evidence needed.
If somebody applies on your behalf they should include a letter of endorsement from an approved authority. By clicking the following link, a pop up window will appear. To close the window, click on the X in the top right corner and you will return to this page. Please click here to see a list of approved authorities.
Note that this application form cannot be saved and if you close the window, any information added will be lost and you will have to start the application process from the start.
EVIDENCE REQUIREMENTS
- A recent payslip or employment contract if applicable. We use this for evidence of your salary and confirmation that you work or have worked in the community.
- Copies of certificates of training and development courses relevant to community practice.
- At least two written quotes or estimates if you are requesting assistance for a specific item or service.
ABOUT YOUR NURSING CAREER
DECLARATION OF YOUR WEEKLY/MONTHLY INCOME & EXPENDITURE
START APPLICATION
Are you a Registered Nurse who is, or have been employed for example as a district nurse, health visitor, school nurse, community specialist nurse, community psychiatric nurse, learning disability nurse, or a community midwife and hold a bank account solely in your own name?
Unfortunately we are unable to help you. Please visit our Links page to view a list of other organisations that may be able to help.
PERSONAL DETAILS OF NURSE
THIRD PARTY APPLICANT
Are you making this application on behalf of the Registered Nurse?
No action needed – please proceed to the next step.
Upload your letter
Max. size: 64.0 MB
TRAINING HISTORY
COMMUNITY NURSING EMPLOYMENT HISTORY ONLY
ABOUT YOUR PRESENT OR PREVIOUS EMPLOYMENT AND/OR RETIREMENT
Are you currently in employment?
Are you currently retired?
Were you retired on health grounds?
HOUSING STATUS
Do you live alone or share accommodation?
DETAILS OF DEPENDENTS
Do you have any dependents?
Living at Home?
Do you want to add another dependent?
Living at Home?
Do you want to add another dependent?
Living at Home?
Do you want to add another dependent?
Living at Home?
Do you want to add another dependent?
Living at Home?
Do you want to add another dependent?
Living at Home?
Please add any additional dependents in the Extra Notes section at the end of the application form.
Do you have savings in any of the following? Please state amounts (£’s only)
Please advise us of the details of your bank account for use if you are awarded a grant; this needs to be a single account held in your name
INCOME
Salary Frequency
EXPENDITURE
Please only list debts and loans which you are solely responsible for.
REASON FOR APPLICATION
FINAL STEP
Have you applied before?
Are you currently applying or have you applied to any other charitable trust in the last 3 years?
WOULD YOU LIKE TO ADD ANOTHER?
WOULD YOU LIKE TO ADD ANOTHER?
If you need to add more, please put them in the Extra Notes section at the end of the application form.
Would any of your existing benefits be affected by this grant?
EVIDENCE REQUIRED
Please provide the following information:
1. A recent payslip, if applicable.
2. Copies of certificates of training and development courses relevant to Community practice.
3. At least two quotes if work is being undertaken and services provided.
Please note that you can select multiple files to upload.
Upload Evidence
Max. size: 64.0 MB
Upload Evidence
Max. size: 64.0 MB
Upload Evidence
Max. size: 64.0 MB
Upload Evidence
Max. size: 64.0 MB
Declaration
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