Personal Grants

Data Protection

Please tick YES/NO below to indicate that you are happy for the information you enter into this application form to be collected and stored for the purpose of processing your application.
Please note that if you select "No" we will be unable to proceed with your application and we will not contact you to discuss your request further.

Are you applying on someone else's behalf?

Relationship to applicant

Other

Section 1 – Representative Details (if applying on behalf of someone else)

Title

First Name

Surname

Mailing Street

Town/City

County

Nation

Postcode

Telephone Number

Date of Birth

Section 2 Details of the Beneficiary - Applicant

If you are applying for yourself and you are either a person with Parkinson’s or you are an unpaid carer for someone with Parkinson’s, please complete this section.

Please note: if you are applying on behalf of someone else, please complete this section with the details of the person you are applying for.

Title

First Name

Surname

Mailing Street

Town/City

County

Nation

Postcode

Telephone Number

Date of Birth

Do you have Parkinson’s or parkinsonism?

Do you care for someone with Parkinson’s or parkinsonism?

Please tell us the year of your diagnosis / the diagnosis of the person you care for

Are you a member of a Parkinson’s UK local group?

How may we contact you about this application?

EmailTelephoneLetter

You may only apply for items in ONE of the four categories below.

Please note: you cannot apply for an item or service if you or your carer have been previously awarded this item or service from a Parkinson’s UK personal assistance grant.

Which category are you applying for?

Please provide clear details of the product or service you are applying for

Section 4 How will a Parkinson’s UK grant help you?

Our panel will need to know how the item or service you are requesting would make a significant difference to your daily life, either as a person with Parkinson’s or in caring for someone with Parkinson’s.

Please tell us how the item or service you are requesting would improve your daily life with Parkinson’s or caring for someone with Parkinson’s

Section 5 How much do you need?

We need to know how much the item or service you are applying for costs, and how much you are requesting from us up to the maximum award limit for that category.

Total cost of the item or service

Amount you are requesting from Parkinson's UK Grants

Please explain how you will pay the remaining costs after our funding contribution from your grant award has been paid to the supplier

Section 6 Your finances

You must tell us the total sum of any savings or investments you have, including your partner’s savings if you are living together. Total savings include those held in bank accounts and/or building societies, stocks and shares, gilts, bonds, ISAs or any other savings.

Please note that you may be asked to provide recent evidence of your savings as declared on your application form.

Please tell us your total savings as outlined above.

Disability Living Allowance mobility component

Lower RateHigher RateDo not receive

Disability Living Allowance care component

Lowest RateHighest RateMiddle RateDo not receive

Personal Independence Payments

	Standard Rate	Enhanced Rate	Do not receive
Personal Independence Payment (PIP) daily living component
Scottish Adult Disability Payment
Personal Independence Payment (PIP) mobility component

Attendance Allowance

LowerHigherDo not receive

Other Benefits

Have you had a benefits check recently?

YesNo

If not, would you like us to refer your details to our advisors who can advise you on how to arrange one?

YesNo

Section 7 Information to support your application

Our grants panel can only consider your application if you send us ALL the required supporting information for the item or service you are applying, as outlined and defined in our guidance and criteria.

Supporting Information Required

Letter of Support – from a specialist health or social care professional, referring directly to your application and why the item/service is suitable and would improve your wellbeing. Please include examples.

Quotes – required quotes for the <item> you are asking us to fund.

Evidence of Assessment/Trial – proof that you have been assessed for or tried the item or service in person, showing it is suitable and safe for you to use.

Local Services Evidence – confirmation that you asked your local health or social care service for help, and explanation of why they could not provide it.

Home Adaptation Details – detailed information about the adaptation requested, plus evidence of your Disabled Facilities Grant application and its outcome.

Note: The total size of all uploaded files must not exceed 30 MB. Please compress or remove files if the combined size is larger.

Physical Activities – Supporting Information Required

1 quote required
Letter of support required (Parkinson’s Nurse, Occupational Therapist, Physiotherapist, Parkinson’s UK Local Advisor, Paid Carer, Doctor, Social Prescriber, Social Worker)
Local authority evidence – request dependent

The documentation requested is required to process your application. If you are unable to provide all of the information at this stage, please be aware that this may delay the progression of your application.

Electrical or Household Items – Supporting Information Required

2 quotes required
Letter of support required (Parkinson’s Nurse, Occupational Therapist, Physiotherapist, Parkinson’s UK Local Advisor, Paid Carer, Doctor, Social Prescriber, Social Worker)

Specialist Equipment – Supporting Information Required

2 quotes required
Letter of support required (Parkinson’s Nurse, Occupational Therapist, Physiotherapist, Speech & Language Therapist, Parkinson’s UK Local Advisor)
Evidence of safe use required
Local authority evidence – request dependent
Detailed information – request dependent

Home Adaptations – Supporting Information Required

2 quotes required
Letter of support required (Occupational Therapist only)
Local authority evidence required
Disabled Facilities Grant: evidence required
Detailed information required

Letter of Support

Quotes

Evidence of Assessment/Trial

Local Services Evidence

Home Adaptation Details

Section 8 Declaration

Please select the statement that describes you

Section 8.1 Applicant’s declaration (This is if they select " I Am Applying for Myself)

If you are a person with Parkinson’s or care for someone with Parkinson’s and you are applying for yourself, please complete and sign this section:

Full Name

Signature

Date of Signature

Section 8.2 Advocate or representative’s declaration (This is if they select " I Am Applying for Some)

If you are a person with Parkinson’s or care for someone with Parkinson’s and you are applying for yourself, please complete and sign this section:

Full Name

Signature

Date of Signature

Monitoring information (separated from application and anonymised upon receipt)

What is your sex?

Are you currently in a paid or unpaid employment position?

How do you describe your ethnicity?

Other (Ethnicity)

What are your living arrangements?

How did you hear about Parkinson's UK Grants?

	Contributory	Income-related	Do not receive
Carer's Credit
Employment and Support Allowance