Apply for Support Our Application Form is undergoing some minor tweaks and is currently unavailable. It will be back online shortly. In the meantime you can download the Application Form from the resource section here: Caudwell Children Application Form For any enquiries please contact: applications@caudwellchildren.com Thank you for your patience. Step 1 of 15 6% Apply For Support To apply for support from Caudwell Children please complete the form below. If you would like to apply for Destination Dreams, please complete the Destination Dreams Application Form here.Do the child’s parents/guardians earn less than £45K gross per annum?*YesNoIs the child aged 18 or under?*YesNoDoes the family live legally in the UK?*YesNoWe are sorry that at this time you do not fall within Caudwell Children’s criteria.For further help and advise please visit our charity links section. What service are you applying for?*Please choose ONE of the following.Powered WheelchairsSpecialised EquipmentTherapy for Cerebral Palsy & Brain Related DisordersTreatment - Selective Dorsal Rhizotomy (SDR)Enable SportDestination DreamsDestination Dreams is an annual group holiday for 25 families with children fighting a life-threatening condition. Unfortunately we are no longer accepting applications for our forthcoming Destination Dreams trip Powered Wheelchairs*80% of the total costPowered Wheelchairs (Certain models only and when outside wheelchair services criteria.)Specialised Equipment*70% of the total costSpecialised Buggies & storm/rain covers (Includes storm/rain covers for NHS provided buggies.)Therapy Tricycles (Self-propelled only and to a maximum value of £2,500)Caudwell Children Sensory Packs (We will send you a leaflet in the next stage of the process)Specialised Car SeatsSpecialised Car HarnessesTherapy for Cerebral Palsy & Brain Related Disorders*Maximum of £1,000 per child per annumConductive EducationCraniaa Neuro Rehab Centre (Northern Ireland only)Treatment - Selective Dorsal Rhizotomy (SDR)*Special SDR FundFundraising Support for SDR (UK & USA)Special Fund £2,500 - £5,000 towards the SDR surgery in the UK or USA, dependant on the cost of the surgery.Fundraising Support for SDR (UK & USA) Other treatment abroad and/or social costs associated with that treatment may be considered following research and discussion with healthcare professionals. This process may take some time. To continue your application for Fundraising Support please click hereThe Enable Sport Programme provides specifically designed sports equipment to enable disabled children and young people to participate in competitive sport. Availability of the programme is reliant on sponsorship and appeals. To continue your application for Enable Sport please click here Caudwell Children Criteria The child must be 18 years old or under at the time of application and the application must be fully completed prior to their 19th birthday. The child and their parents must be legal residents of the United Kingdom, Isle of Man or the Channel Islands. The child must have a chronic illness or disability. Support is only available to families whose joint wages/salaries are less than £45,000 gross per annum. Caudwell Children will need proof of income from the parents or guardians, and any benefits, saving and assets will also be taken into account. Should you not wish to disclose your financial details, your application cannot be considered. Caudwell Children only provides support for the programmes/projects listed on the front page of this application form. The child must satisfy Caudwell Children’s criteria for each programme/project. Application Guidelines Support is limited to one donation per child, per calendar year. Caudwell Children provide a maximum of 70% of the funds required for equipment under £5,000 and a maximum of 80% of the funds required for equipment over £5,000. Caudwell Children are unable to consider applications for equipment (excluding powered wheelchairs) over £2,500. Support within the STEP Programme is limited to £1,000 per child per annum. An application may be made on behalf of a child in foster care, however means testing may apply for long-term placements. If you have received a large sum in compensation by way of a legal claim in regards to the child’s condition, you will not be eligible for funding. Proof/confirmation of the child’s condition in written form will be required from a professional body or health care professional, as will confirmation that the item requested is suitable for that child. Caudwell Children is responsible for the ordering of any equipment or service. Caudwell Children cannot pay any monies into other funds or collections and cannot in any circumstances reimburse families for money already spent. Caudwell Children is unable to consider providing any piece of equipment or service that has been ordered or purchased before the application has been approved. Suppliers must be registered with Caudwell Children. The application form must be completed truthfully and signed. In rare circumstances a visit may be required from a Caudwell Children representative. Caudwell Children does not make donations to other charities, trusts or organisations. All requests for support must be by application form and be on behalf of a specific child. All applications are at Caudwell Children’s discretion and are subject to the availability of funds. An application may be declined where a family has a significant level of savings, assets or household income. Caudwell Children reserves the right to decline support.Agreement* By ticking this box, you agree with the above Criteria & Guidelines. Applicant DetailsThe details of the person filling out the form, not the Beneficiary’s details.Name* First Last Address* Address Line 1 Address Line 2 Town/City County Post Code Phone Number*Email Address* Relationship to beneficiary?*The beneficiary is the child/young person who you are applying for. Beneficiary DetailsThe child/young person on whose behalf you are applying.Name* First Last Other namesThis is other names the child is or has been known by. First Last Date of Birth*The beneficiary must not be over 18 Years old. Male/Female?*MaleFemaleNHS number Details for Beneficiary’s Parent(s)/Guardian(s)Name of Parent/Guardian 1* First Last Name of Parent/Guardian 2 First Last Address* Same as applicant address Address Line 1 Address Line 2 City County Post Code Time at current address*Click to add a phone number* Mobile Number Home/Evening Phone Number Work Phone Number Mobile Number*Home/Evening Phone Number*Work Phone Number*Email Address* UK Residential Status*UK CitizenEEA/EU CitizenSettled in the UK (indefinite leave to enter or remain in the UK)Refugee statusInternational studentUK passport number OR National Insurance Number*(Do not leave blank)Marital status*Civil partnershipMarriedCohabitatingSingle parentWidowedDivorcedSeparatedResidential status*OwnerTenantLiving with parentsWhat type of house*DetachedSemi-detachedFlat/apartmentTerrace/town houseNumber of dependent children*Not including the beneficiary child/young person.0123456788+Name (Child 1)* First Last Date of Birth (Child 1)* Name (Child 2)* First Last Date of Birth (Child 2)* Name (Child 3)* First Last Date of Birth (Child 3)* Name (Child 4)* First Last Date of Birth (Child 4)* Name (Child 5)* First Last Date of Birth (Child 5)* Name (Child 6)* First Last Date of Birth (Child 6)* Name (Child 7)* First Last Date of Birth (Child 7)* Name (Child 8)* First Last Date of Birth (Child 8)* ApplicationDetails of main diagnosis*e.g. cerebral palsy, autismDonation/item(s) requested*Cost of donation/item(s) requested*Please note that the maximum award for therapy under STEP is £1,000.Background information/history*How the child’s disability affects their daily life*Difference this donation would make to the child and your family*Father / Guardian 1 EmploymentFull-TimePart-TimeUnemployedMother / Guardian 2 EmploymentFull-TimePart-TimeUnemployedTotal gross earning of parents/guardians*Please DO NOT leave this field blank.Additional financial informationCheck any that apply. Include only if they live in the child’s main home. Benefits Pension Maintenance Savings Mortgage outstanding Other assets Other Total amount of benefits income (pm)*Total amount of pension income (pm)*Total amount of maintenance income (pm)*Total amount of savings*Total mortgage outstanding*Total other assets*Other* Father/Guardian 1 Employment DetailsLeave this section blank if you are currently unemployed. Father/Guardian 1 job titleName of employerEmployer Address Address Line 1 Address Line 2 City County Post Code Duration of employmentMother/Guardian 2 Employment DetailsLeave this section blank if you are currently unemployed. Mother/Guardian 2 job titleName of employerEmployer Address Address Line 1 Address Line 2 City County Post Code Duration of employmentPrevious employers within the last nine yearsThis is to signpost you to other charities who may be able to help with any balance of funds needed for equipment. Other InformationHave you raised any funds towards the requested item*YesNoHow much funding have you raised?*Details of other charities/organisation applied to and any funds securedHave you previously been supported by Caudwell Children?*YesNoHave you received any compensation by way of a legal claim in regards to the child’s/young person’s condition?*YesNoPlease specific amount received*Are you currently pursuing a legal claim in regards to the child’s/young person’s condition?*YesNoPlease give details*Do you believe your child’s injury/disability is as a result of another person’s fault or negligence?*YesNoHave you sought legal advice?*YesNoPlease tell us how you heard about Caudwell Children* ConsentOne of the most effective ways to help Caudwell Children is to give consent for us to use your information to help with raising awareness and fundraising. We accept that consent can be changed at any time by the child/young person and/or their parent/guardian.*Please tick all that apply: I give consent for Caudwell Children to use my child’s details (e.g. first name, age, condition, general area) for general marketing purposes including online I give consent for Caudwell Children to use the photographs associated with this application that I have provided, for the same purposes as above I do not wish to give consent If you would like to hear more about our services, latest news, campaigns and how you can support our life changing work, let us know. You can update your preferences anytime. Yes please, I'd like to hear from Caudwell Children by email. Please be aware that should your application progress further, Caudwell Children will require additional information. Contract AgreementContract Agreement*All 4 boxes must be ticked to continue. I confirm that all the details that I have provided within this form and true and correct to the best of my knowledge. I understand that failure to disclose full details could invalidate my application I understand that Caudwell Children may need to discuss your application with the healthcare professionals/suppliers involved in it I understand that if Caudwell Children do not receive all the supporting documents within six months from the initial request, then my application will be closed I understand that no money will be paid directly to myself and that Caudwell Children will not reimburse any money that I have already spent Name* First Last Signature*Date* Equalities Monitoring FormPlease provide the following information for the beneficiary (the child / young person on whose behalf you are applying)Nationality & Ethnic OriginWhite - BritishWhite - IrishOther White BackgroundBlack - BritishBlack - CaribbeanBlack - AfricanOther Black BackgroundAsian - BritishAsian - IndianAsian - PakistaniAsian - BangladeshiOther Asian BackgroundChineseMixed BackgroundOther Ethnic BackgroundPrefer not to answerPlease select one option from the list.Age0 - 45 - 910 - 1415 - 18Prefer not to answerPlease select one option from the list.ReligionChristianJewishMuslimHinduNoneOtherPrefer not to answerPlease select one option from the list.GenderMaleFemalePrefer Not to AnswerFirst LanguageSecond Language Please provide the following information for the applicant (person filling out this form)Nationality & Ethnic OriginWhite - BritishWhite - IrishOther White BackgroundBlack - BritishBlack - CaribbeanBlack - AfricanOther Black BackgroundAsian - BritishAsian - IndianAsian - PakistaniAsian - BangladeshiOther Asian BackgroundChineseMixed BackgroundOther Ethnic BackgroundPrefer not to answerPlease select one option from the list.Age16 - 1920 - 2930 - 3940 - 4950 - 5960+Prefer not to answerPlease select one option from the list.ReligionChristianJewishMuslimHinduNoneOtherPrefer not to answerPlease select one option from the list.GenderMaleFemalePrefer Not to AnswerFirst LanguageSecond LanguageParent / Guardian Disability statusI consider myself to be a disabled personI do not consider myself to be a disabled person
To apply for support from Caudwell Children please complete the form below. If you would like to apply for Destination Dreams, please complete the Destination Dreams Application Form here.
Special Fund £2,500 - £5,000 towards the SDR surgery in the UK or USA, dependant on the cost of the surgery.
Fundraising Support for SDR (UK & USA) Other treatment abroad and/or social costs associated with that treatment may be considered following research and discussion with healthcare professionals. This process may take some time.
