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If you’re caring for someone who cannot manage without your help and support due to an illness, disability, mental health problem or addiction—and you’re not employed to do this—you are a carer. Newcastle Carers is here to listen and support carers of all ages. If you are a carer looking after someone who lives in Newcastle, you may be able to access a small grant called the Carers Wellbeing Fund. The fund is intended to support carers and to improve their own health and wellbeing. The money is provided by Newcastle City Council and the Newcastle Gateshead Clinical Commissioning Group (NHS) and is administered by Newcastle Carers, an independent charity who provide information, advice and support to carers. It is important that you read the full terms and conditions of the Carers Wellbeing Fund and keep a copy for your reference, you can view them here: www.newcastlecarers.org.uk/carers-wellbeing-fund-terms-and-conditions/What to expect from completing this secure form: Any information shared with Newcastle Carers via this form will be stored securely, please see https://www.newcastlecarers.org.uk/privacy-policy/ for more details. If you would like any further information, please call 0191 275 5060 and speak to one of our friendly team members.
Once this form has been submitted a member of the team will contact you within 10 working days to talk to you about your situation and how we can help. As part of that conversation additional information will be gathered to support your application to the Carers Wellbeing Fund. If a worker is unable to contact you, your application to the fund will not be progressed, please ensure the information that you provide on this form is correct. If you need help to complete this form contact Newcastle Carers and we will be happy to support you.
Are you an adult carer (over 18 years old) or a young carer (aged under 18)?
Have you read and accepted the terms and conditions? www.newcastlecarers.org.uk/carers-wellbeing-fund-terms-and-conditions/*
Does the person that you look after live in Newcastle?*
Tell us about you:
First name(s)*
Surname*
Date of Birth*
Gender*
Do you have any illnesses or disabilities?
What is your ethnicity?
What is your sexual orientation?
How can we contact you?
Your address*
Address Line 2
Address Line 3
City
Postcode*
Preferred Contact Telephone Number:*
Landline Telephone Number:
Email Address:
Newcastle Carers will add your details to their confidential database. Do you consent to receiving support from Newcastle Carers?*
Young Carers Details:
First names(s)*
Your address:*
Address line 2
Address line 3
City:
Postcode:*
Young Carers' Telephone Number:
Telephone Number of a parent/guardian:
Please note: if the young person is under 16 we will contact the parent first, before contacting the child.
Does the parent of this young carer have an email address? (if yes, please provide)
If the young carer is under 16 please provide details of the person/people with parental responsibility e.g. their Mam or Dad:
Does the young carer have their own email address?(if yes, please provide)
Newcastle Carers will add your details to their confidential database. Do you consent to being contacted by Newcastle Carers?
Tell us about the person that you look after:
First name of the person you care for:
Surname of the person you care for:
What is their date of birth?
What is their main disability?*
Do you care for more than one person? (if yes the additional details will be collected when you are contacted by a member of our team)*
Additional information:
Are there any risks that you want our staff to know about?
Where did you hear about Newcastle Carers?
Financial Information:
The information that you provide in this section will not impact on your application, the Carers Wellbeing Fund is not means tested. We ask this information to highlight the impact of our work and the financial difficulties that carers face.
How many people live at your home address?
What is your approximate household income?
What are you applying to the Carers Wellbeing Fund for?
Please select what you are applying to the Carers Wellbeing Fund for:
Please provide a link to the item requested (e.g. copy and paste a weblink so that we can see what you are hoping to purchase).
Please note: As described in the terms and conditions DO NOT purchase the item until you have been informed that your application has been successful. We cannot award grants for items already purchased.
How much money are you applying to the Carers Wellbeing Fund for? (maximum £200)
Please select how you feel this will benefit you the most:
Please do not forget that if the grant is awarded you must return receipts, the best way to do this is to email a photo of the receipts to: info@newcastlecarers.org.uk within one month of purchasing the item.
Please note: As described in the terms and conditions DO NOT purchase the item until you have been informed of the outcome of your application. We cannot award grants for items already purchased.
Which GP surgery are you registered with?
Which school do you attend?
Please note: Newcastle Carers may contact your school and/or GP surgery to discuss information in this application
Are you eligible for free school meals?
Contact details of a professional that supports you:
This is an optional question. It may speed up your application if you provide us with the details of a professional that is currently supporting you or your family and is aware of your caring role. Please gain their consent to share their details, Newcastle Carers may contact them to discuss the support that we provide.
First Name:
Last Name:
Organisation they work for:
Mobile Telephone Number: