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 If you need help in reading or understanding anything in this form then please ask us and we will be happy to help If the item you need is not listed below, we are unfortunately unable to help. Equipment applications must be supported by an Occupational Therapist or healthcare professional. We can provide 70% to 80% of the total cost of equipment. You will need to put some money towards it or find another charity or funder who can help with the cost. 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.Does the family live legally in the UK?*YesNoIs the child aged 18 or under?*YesNoDo the child’s parents/guardians earn less than £45K gross per annum?*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 Buggies & Storm/Rain CoversTherapy TricyclesMulti-sensory EquipmentSpecialised Car Seats and Car HarnessesConductive EducationSelective Dorsal Rhizotomy (SDR)Destination DreamsSports EquipmentSDR*Selective Dorsal Rhizotomy (SDR) Special FundSelective Dorsal Rhizotomy (SDR) Fundraising Support UK & USAPost-SDR Rehabilitative Physiotherapy/Strength ConditioningSports Equipment Prerequisites*I have spoken to Caudwell Children and would like to apply for Sports EquipmentI haven't spoken to Caudwell Children - how can I contact you?The child must already be competing in the sport. Please speak to us before applying as funding is now always available.80% of the costCertain models only and if they cannot be provided by wheelchair services.70% of the total costCertain models only and if they cannot be provided by wheelchair services. This includes storm/rain covers for buggies provided by the NHS. Please see guidelines regarding the cost.70% of the total costThe total cost of the tricycle must be less than £2,500 and the child must be able to propel it themselves.70% of the total costWe will send you a leaflet showing the choices. Applications must be supported by an Occupational Therapist.70% of the total costThe total cost of the car seat must be less than £3,000This must be at a centre that we have approved. We can provide up to £1,000 for each child every 12 months.£2,500 or £5,000 towards the SDR surgery dependant on the cost of the operationFundraising 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 here20% of the cost of a block of therapy or training (minimum total cost £1,000/£200 donation)The balance of the money for the surgery or therapy must be transferred to Caudwell Children so that the total amount can be paid to the hospital or therapist.Before applying please call us on on 0345 300 1348 or email charity@caudwellchildren.comDestination 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 Caudwell Children Criteria The child you are applying for must be less than 19 years old. The whole application process must be completed before their 19th birthday. The child and their parents or guardians must be living legally in the United Kingdom. The child must have a chronic illness or disability. If you and your partner together earn more than £45,000 before tax each year, we are regrettably unable to help. To see if we can help you, we will look at your income, benefits, savings and assets. We will ask for proof of your income such as your payslips. If you do not wish to give us this information we cannot consider your application. Caudwell Children can only provide help with the items listed on the front page of this form. Application Guidelines All applications must be for an individual child and be made on our application form. We can help a child once every 12 months. If the equipment you need costs less than £5,000 we can provide 70% of the cost. If the equipment you need costs more than £5,000 we can provide 80% of the cost. The total cost of the buggy must be less than £1,500 for one child. If the buggy is for two children, it can be more than this. If you are a foster carer who has been looking after a child for more than two years, we will look at your financial situation. If you have received a large sum of money in compensation for medical negligence because of your child’s condition we unfortunately cannot help you. We will need a letter stating the name of your child’s condition from your doctor, hospital or clinic. We will ask you for this later. We will need an Occupational Therapist or Physiotherapist to complete a form saying that any equipment you have asked for is suitable for your child. We will ask you for this later. Caudwell Children must order the equipment or service. We cannot make payments to parents or to a child’s fundraising account. We cannot pay you back if you have already bought the equipment or paid for a service. We can only use suppliers who are registered with us. We cannot make donations or payments to other charities, trusts or organisations. Caudwell Children will look at all applications and decide if they can be supported. It will be affected by how much money the charity has available. Caudwell Children reserves the right to decline support. Caudwell Children reserve the right to turn down requests for support. You must tell the truth on the application form and you must sign it at the end. Agreement* By ticking this box, I confirm that I have read and understood the above criteria and guidelines. Your DetailsThis is the person filling out the formName* First Last Contact Number*Email Address* Relationship to the child?* Child's DetailsName* First Last Date of Birth*The beneficiary must not be over 18 Years old. Other/previous NamesThis is other names the child is or has been known by. First Last Address* Street Address Address Line 2 City County Post code Male/Female?*MaleFemaleNHS numberIf you do not know the NHS number leave it blank. Please do not make this up. Child's Parents/GuardiansParent/Guardian 1* MrMrsMissMs Prefix First Last Address Click here if address is same as child's address Address Address Line 1 Address Line 2 City County Post Code 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* Relationship to the child*Does this person have parental responsibility?*YesNoParent/Guardian 2 MrMrsMissMs Prefix First Last Address Click here if address is same as child's address Address Address Line 1 Address Line 2 City County Post Code Click to add a phone number Mobile Number Home/Evening Phone Number Work Phone Number Mobile NumberHome/Evening Phone NumberWork Phone NumberEmail Address Relationship to the childDoes this person have parental responsibility?YesNoPlease provide the information below for the parent/guardian that the child lives with Marital status*Married/Civil partnershipCohabitatingSingleWidowedDivorcedSeparatedResidential status*OwnerTenant Tell us about your other childrenChildren living with you who are under 18 years old.NameDate of birth ApplicationMain diagnosis of your child*e.g. cerebral palsy, autismWhat are you asking for help towards?*What is the total cost of it?*Please estimate if you do not know the exact amount)Background information/history*How the child’s disability affects their daily life*Tell us how the donation will help your children and your family* Your incomings and outgoingsYou will need to add these up for the people that are living in the child's main home.Additional financial informationCheck any that apply. Include only if they live in the child’s main home. Wages or salaries Benefits Pension Maintenance Savings Mortgage outstanding Other assets Other Total amount of wages or salaries per year:*Wages or salaries before any deductions made, e.g. tax - total per month.Total amount of benefits income per month:*Benefits, e.g. DLA, income support, tax credits, housing benefits - total per monthTotal amount of pension income per month:*Total amount of maintenance income per month:*Total amount of savings*Total mortgage outstanding*Total other assets*For example property that you own, stocks or sharesOther* 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 funding foundPlease tell us how you heard about Caudwell Children* Employment Information & ConsentOne of the ways for you 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. If you do not wish to give consent, this will not affect the outcome of your application.Employment Status - Parent 1*EmployedSelf-employedUnemployedParent1/Guardian 1 - Name of employere.g. Tesco, B&Q, The Accountancy FirmEmployment Status - Parent 2*EmployedSelf-employedUnemployedParent2/Guardian 2 - Name of employere.g. Tesco, B&Q, The Accountancy FirmWe will use the following information to help us to focus on organisations that may be able to help us with fundraising. We would never use your name or pass on any details that would identify you. I give consent for Caudwell Children to use the following information in order to focus their fundraising efforts. I give consent for Caudwell Children to use my child's details (e.g. first name, age, condition, general location) for general marketing purposes including online. I give consent for Caudwell Children to use the photographs that I will provide for this application, for general marketing purposes including online. 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 would like to hear from Caudwell Children by email. Signature Contract AgreementI confirm that all the details that I have provided in this form are true and correct to the best of my knowledge. I understand that Caudwell Children will need more information and documents from me. I understand that if I don’t provide all the information requested within six months then my application will be closed. I understand that Caudwell Children may need to discuss my application with the healthcare professionals/suppliers involved in it. I understand that money will not be paid directly to me and that Caudwell Children will not refund any money that I have already spent. Name* First Last Signature Data Protection The General Data Protection Regulations 2018 give new guidance on how organisations need to control and process the information that you share with us. As a Charity providing practical and emotional support to disabled children across the UK, we need to process your data to pursue our legitimate business interests, for example to provide our services, to safeguard vulnerable children and adults and for administrative purposes. If your application is successful, the Charity will securely retain and process the information provided in this form, together with any associated information during the time we provide services to you and afterwards until your child reaches 26 years in line with General Data Protection Regulations and Caudwell Children's Privacy of Information Policy. If your application is unsuccessful, all documentation relating to your application (both paper and electronic) will be confidentially destroyed after a period of six months. Contact Details Caudwell Children Caudwell International Children's Centre Innovation Way Keele Science & Innovation Park Newcastle-under-Lyme Staffordshire ST5 5NT Tel: 0345 300 1348 Email: application@caudwellchildren.com The Process1 - Application Form Assessment of the application form by the Applications Department. 2 - Supporting Documents Request for supporting documents. If we have not received the supporting documents after six months we will assume that you do not wish to continue with your application and it will be closed. All paper documents relating to the application will be securely destroyed. If you are having difficulty in returning these documents, please call us and we can give you more time. Assessment of completed file by the Applications Department. We will try to assess your application as quickly as we can. As a guideline, this may take anywhere between one and six months, depending on: How complicated your application is How quickly you return the documents we have asked for How much money we have available. 3 - Assessment by Head of Applications Service 4 - Decision Decision by the CEO or a Trustee of Caudwell Children We will write a letter to the child’s parents or guardians informing them of the decision. Caudwell Children is unable to give decisions over the telephone. Sometimes things do get lost in the post. Although we do not encourage you to chase your application, if you do not hear from us within one month of sending us your information then please contact us. Whilst we aim to process all applications as quickly as possible, we do ask you to be patient. We will not tolerate any verbal abuse, swearing or rudeness to our staff or volunteers and this will result in your application being declined. If you need help in reading or understanding anything in this form then please ask us and we will be happy to help. 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
If you need help in reading or understanding anything in this form then please ask us and we will be happy to help
If the item you need is not listed below, we are unfortunately unable to help. Equipment applications must be supported by an Occupational Therapist or healthcare professional.
We can provide 70% to 80% of the total cost of equipment. You will need to put some money towards it or find another charity or funder who can help with the cost.
80% of the costCertain models only and if they cannot be provided by wheelchair services.
70% of the total costCertain models only and if they cannot be provided by wheelchair services. This includes storm/rain covers for buggies provided by the NHS. Please see guidelines regarding the cost.
70% of the total costThe total cost of the tricycle must be less than £2,500 and the child must be able to propel it themselves.
70% of the total costWe will send you a leaflet showing the choices. Applications must be supported by an Occupational Therapist.
70% of the total costThe total cost of the car seat must be less than £3,000
This must be at a centre that we have approved. We can provide up to £1,000 for each child every 12 months.
£2,500 or £5,000 towards the SDR surgery dependant on the cost of the operation
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.
20% of the cost of a block of therapy or training (minimum total cost £1,000/£200 donation)The balance of the money for the surgery or therapy must be transferred to Caudwell Children so that the total amount can be paid to the hospital or therapist.
Before applying please call us on on 0345 300 1348 or email charity@caudwellchildren.com
Please provide the information below for the parent/guardian that the child lives with
One of the ways for you 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. If you do not wish to give consent, this will not affect the outcome of your application.
The General Data Protection Regulations 2018 give new guidance on how organisations need to control and process the information that you share with us.
As a Charity providing practical and emotional support to disabled children across the UK, we need to process your data to pursue our legitimate business interests, for example to provide our services, to safeguard vulnerable children and adults and for administrative purposes.
If your application is successful, the Charity will securely retain and process the information provided in this form, together with any associated information during the time we provide services to you and afterwards until your child reaches 26 years in line with General Data Protection Regulations and Caudwell Children's Privacy of Information Policy.
If your application is unsuccessful, all documentation relating to your application (both paper and electronic) will be confidentially destroyed after a period of six months.
Caudwell Children
Caudwell International Children's Centre
Innovation Way
Keele Science & Innovation Park
Newcastle-under-Lyme
Staffordshire ST5 5NT
Tel: 0345 300 1348
Email: application@caudwellchildren.com
Assessment of the application form by the Applications Department.
Request for supporting documents.
If we have not received the supporting documents after six months we will assume that you do not wish to continue with your application and it will be closed. All paper documents relating to the application will be securely destroyed. If you are having difficulty in returning these documents, please call us and we can give you more time.
Assessment of completed file by the Applications Department.
We will try to assess your application as quickly as we can. As a guideline, this may take anywhere between one and six months, depending on:
Decision by the CEO or a Trustee of Caudwell Children
We will write a letter to the child’s parents or guardians informing them of the decision.
Caudwell Children is unable to give decisions over the telephone.
Sometimes things do get lost in the post. Although we do not encourage you to chase your application, if you do not hear from us within one month of sending us your information then please contact us.
Whilst we aim to process all applications as quickly as possible, we do ask you to be patient. We will not tolerate any verbal abuse, swearing or rudeness to our staff or volunteers and this will result in your application being declined.
If you need help in reading or understanding anything in this form then please ask us and we will be happy to help.
