Welcome to the online application form. If you would prefer a copy to download and fill in, you can download it by clicking here.

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.

ABOUT YOUR NURSING CAREER

DECLARATION OF YOUR WEEKLY/MONTHLY INCOME & EXPENDITURE

  • STEP 1
  • STEP 2
  • Step 3
  • STEP 4
  • STEP 5
  • STEP 6
  • STEP 7
  • STEP 8
  • STEP 9

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: 10.0 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: 10.0 MB

Upload Evidence

Max. size: 10.0 MB

Upload Evidence

Max. size: 10.0 MB

Upload Evidence

Max. size: 10.0 MB

Declaration

Please note our Privacy Policy; By clicking I ACCEPT on this form you confirm you have read, understood and consent for us to use your information in the manner as stated therein.

I ACCEPT

If your application does not fall within our criteria will you give us permission to send your details to another charity if we feel they may be able to help you?