Apply for Funding

Get Help

Apply for Funding

PLEASE NOTE IF YOU HAVE ANY DIFFICULTY COMPLETING OR SUBMITTING THIS FORM IN TERMS OF COMPLETING OR SUBMITTING, OR YOU DO NOT HEAR FROM BACK US WITHIN 4 WEEKS, CONTACT US AT enquiries@physcap.org or call 0845 051 9156

Eligibility Criteria

Children and young people eligible to receive funding support must:

Have a physical and/or learning disability
Be a United Kingdom citizen
Be under the age of 18 years and applications must be made before the child’s 18^th birthday

Schools and organisations who currently work with or support children and young people with disabilities who meet our eligibility criteria, are also eligible to apply for PhysCap funding support.

Before you begin your application…

For PhysCap to consider your funding request, it must be recommended or approved by an Occupational Therapist, Physiotherapist or Educational Psychologist. We will require a supporting letter to be uploaded with your application form.
Please note that PhysCap require a minimum of two official price quotes which if possible should be uploaded with your application form.
As much as we try our very best to process applications as quickly as possible this could be a lengthy process; please be patient.

PhysCap will not consider funding requests for:

Motor vehicles
Holidays
Extensions or home improvements
Garden renovations
Tablets or Smartphones

Get Help

Apply for Funding

Eligibility Criteria

Children and young people eligible to receive funding support must:

Have a physical and/or learning disability
Be a United Kingdom citizen
Be under the age of 18 years and applications must be made before the child’s 18^th birthday

Schools and organisations who currently work with or support children and young people with disabilities who meet our eligibility criteria, are also eligible to apply for PhysCap funding support.

Before you begin your application…

For PhysCap to consider your funding request, it must be recommended or approved by an Occupational Therapist, Physiotherapist or Educational Psychologist. We will require a supporting letter to be uploaded with your application form.
Please note that PhysCap require a minimum of two official price quotes which if possible should be uploaded with your application form.

PLEASE NOTE IF YOU HAVE ANY DIFFICULTY COMPLETING OR SUBMITTING THIS FORM IN TERMS OF COMPLETING OR SUBMITTING, CONTACT US AT enquiries@physcap.org or call 0845 051 9156

PhysCap will not consider funding requests for:

Motor vehicles
Holidays
Extensions or home improvements
Garden renovations
Tablets or Smartphones

Child's details...

1. First Name

2. Surname

2. DOB

4. Gender

5. Is your child in nursery or school full time or part time?

6. Name of School/ Nursery

7. Does your child currently have an EHCP/EHP (Education and Health Care Plan, Early Help Plan) :

8. Details of child’s condition or diagnosis if known:

9. Does your child live with you on a full time or permanent basis?

10. If not, please give details.

11. Select the Rate of DLA or PIP your child has been awarded:

12. If your child does not get DLA or PIP have you:

13. Have you applied to other charities and if so who were they and what was the outcome:

14. Have your applied for any statutory financial assistance for this item? Please give details

Parent / Guardian Details

16. First Name

17. Surname

18. House number / name and street

19. City

20. Postcode

21. Home Telephone

22. Mobile Telephone

23. Email

24. Occupation

25. Relationship to Child

26. Number of children aged under 17 living in the household and their ages:

27. Have you been living in the UK for the past 6 months?

28. If no, give details:

29. I am British:

30. If you are not British – do you have a current legal residency in the UK and have recourse to public funds?

31. If yes please send confirmation of your residential status with this Application

32. Do you require an interpreter to talk about your application? If yes, in which language?

Alternatively can you give details of someone who can speak on your behalf:

34. Name:

35. Job Title:

36. Address:

37. Email:

38. Phone:

Your Partner

(by this we mean the person who lives with you for example husband, wife, civil partner, boyfriend, girlfriend)...

41. Title:

42. Full Name:

43. Address:

44. Email:

45. Mobile:

46. Your partner’s relationship to the child you are applying for:

47. Is your child the subject of a local authority care order (adopted, Looked After or subject to a Special Guardianship Order). Please give details:

OT or Physio...

49. Title:

50. First Name:

51. Surname:

52. Address:

53. Phone:

54. Email:

54a. Upload your OT report

Household Income...

Please select annual income and give evidence (examples may include payslips, benefits, pension, self-assessment.)

57. Household Income:

58. Total Savings:

59. Evidence:

60. Monthly rent/mortgage amount::

Do you/your partner or any parent of the child you are applying for (even if living in a different household) receive any of the following.

Where applicable enter who receives the benefit and the amount (specify monthly or annual)

63. Universal Credit::

64. Child tax credits:

65. Income based job seekers allowance:

66. Employment support allowance:

67. Housing benefit:

68. Council Tax benefit:

69. Working tax credits:

70. Income support:

71. Incapacity benefit:

72. Pension credit:

73. Carers Allowance:

Equipment / Therapy Request

Please provide information about how you would like PhysCap to support your child Please include details of the impact this will have on your child’s quality of life and how it will support them with their needs. Please include costings (and also upload the quotes you have received). If relating to therapy please give details of what your child/person you are applying for already has access to.

76. Brief description:

77. How will this equipment/support benefit the child?:

You should provide two quotations for this equipment. Please upload two quotations on headed paper below.

79. Quotation 1

80. Quotation 2

81. Additional information / comments:

82. How did you hear about PhysCap?:

83. If your application is successful, please may we use your story to promote the charity, so we can help more children?

84. Do you give permission for PhysCap and their corporate sponsors to contact you with future events, promotions and offers?:

By submitting this form, you agree that you have provided truthful information to the best of your knowledge. Failure to disclose income or details relevant to your application may result in your application being rejected.

IF YOU ARE STRUGGLING WITH THIS FORM PLEASE EMAIL CHLOE@PHYSCAP.ORG OR CALL 0845 0845 052 2911

Child's details...

First Name

Surname

DOB

Gender

School/ Nursery or child care provision attending (full time/Part time):

Details of professionals currently offering support, names and contact numbers(Physiotherapists, Occupational Therapists, Social Worker)if different to information already provided:

Does your child currently have an EHCP/EHP (Education and Health Care Plan, Early Help Plan) :

Details of child’s condition or diagnosis if known:

Does your child live with you on a full time or permanent basis Please give details

Select the Rate of DLA or PIP your child has been awarded:

If your child does not get DLA or PIP have you:

Have you applied to other charities and what was the outcome:

Is there any statutory financial assistance for this item? Please give details

Parent / Guardian Details

First Name

Surname

House number / name and street

City

Postcode

Home Telephone

Mobile Telephone

Occupation

Relationship to Child

Number of children aged under 17 living in the household and their ages:

Have you been living in the UK for the past 6 months?

If no, give details:

I am British:

If you are not British – do you have a current legal residency in the UK and have recourse to public funds?

If yes please send confirmation of your residential status with this Application

Do you require an interpreter to talk about your application? If yes, in which language?

Alternatively can you give details of someone who can speak on your behalf:

Name:

Job Title:

Address:

Email:

Phone:

Your Partner

(by this we mean the person who lives with you for example husband, wife, civil partner, boyfriend, girlfriend)...

Title:

Full Name:

Address:

Partner Email:

Mobile:

Your partner’s relationship to the child you are applying for:

Is your child the subject of a local authority care order (adopted, Looked After or subject to a Special Guardianship Order). Please give details:

OT or Physio...

Title:

First Name:

Surname:

Address:

Phone:

Email:

Household Income...

Household Income:

Total Savings:

Evidence:

Monthly rent/mortgage amount::

Do you/your partner or any parent of the child you are applying for (even if living in a different household) receive any of the following.

Where applicable enter who receives the benefit and the amount :

Universal Credit::

Child tax credits:

Income based job seekers allowance:

Employment support allowance:

Housing benefit:

Council Tax benefit:

Working tax credits:

Income support:

Incapacity benefit:

Pension credit:

Carers Allowance:

Equipment / Therapy Request

Brief description:

How will this equipment/support benefit the child?:

Cost (£):

Supplier name (we may request a written quotation):

Supplier telephone:

Additional information / comments:

If your application is successful do we have your permission to use your photos for testimonial & publicity literature (web, email, flyers, etc.)?:

Do you give permission for PhysCap and their corporate sponsors to contact you with future events, promotions and offers?:

How did you hear about PhysCap?:

Have you ever applied for funding to PhysCap before this application?:

If your application is successful, please may we use your story to promote the charity, so we can help more children?

IF YOU ARE STRUGGLING WITH THIS FORM PLEASE EMAIL CHLOE@PHYSCAP.ORG OR CALL 0845 0845 052 2911

What will happen now?

Thank you for submitting your application form and supporting documentation, a member of our committee will be in contact with you shortly to confirm that your application has been received. PhysCap assesses applications by conducting home visits and so a member of our committee will contact you to organise this at the most convenient time for you. In the meantime, PhysCap may also contact your named supporting professional to discuss your application. Please keep us informed of any changes that may affect your application.

Note that applications can take some time to process. Please be patient and this is not always a quick process.

Even if your application has been successful, PhysCap cannot guarantee that the full amount you have requested can be funded. Therefore, we urge you to consider alternative ways of fundraising towards your application or contacting and applying to other charities for contributions towards your application.

Apply For Funding

Get Help

Apply for Funding

Get Help

Apply for Funding

Child's details...

Parent / Guardian Details

Your Partner

OT or Physio...

Household Income...

Equipment / Therapy Request

Child's details...

Parent / Guardian Details

Your Partner

OT or Physio...

Household Income...

Equipment / Therapy Request

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