Time to live grant application

First Name*

Surname*

Address line 1*

Address line 2

Town*

Postcode*

Home phone number

Mobile Telephone No.*

Email address*

Gender*

Date of Birth*

Ethnic Group*

Do you have a disability?*

Caring Role

Please outline the names and dates of birth of your cared-for(s) and any conditions they may have

Do you live with the person you care for?*

Who do you care for?*

Tell us about your caring role*

In this section, it would be really helpful if you could tell us a bit about the following:

Who you care for
Their condition(s)
What your caring role involves
How this impacts your day-to-day life

This information helps us understand your situation better so we can make a fair decision on your application. It also allows us to offer you the most relevant information, advice, and support tailored to your caring role.

I have enough time to enjoy activities outside of my caring role*

1 (Strongly disagree)

2 (somewhat disagree)

3 (neither agree or disagree)

4 (somewhat agree)

5 (Strongly agree)

Have you applied for a Time to Live grant in the last 12 months?*

Yes

No

Please let us know who will benefit from this application:

Just me (an individual application)
Me and one or more other carers in my household (Joint household application)
Someone else (please tell us who)

If more than one carer will benefit, please briefly tell us who they are and their relationship to you.

You are eligible to apply for Time to live 12 months after the date of your last application.

If you are unsure of when you last applied you can contact your local Carers Gateway office to find out when you are eligible:

North Ayrshire - 01294 311333

South Ayrshire - 01292 263000

Inverclyde - 01475 602700

What would you like to use your Time to Live award for?*

How many carers will benefit from this grant?*

How many cared for will benefit from this grant?*

Who will benefit from this application?*

To help us consider your application, please include the following information:

What would you purchase with your award? (e.g. item/membership/trip etc)
An approximate idea of the costs involved

Providing these details upfront will help us process your application more smoothly and avoid any delays that might come from us needing to follow up with you.

Please also detail any cared-fors that may benefit from this application as well

How will this grant give you a meaningful break from your caring role?*

In this section we would like you to detail the positive impact that accessing the item or trip you are applying for will have on your caring role.

Highlight the Difference It Will Make

Describe the impact on your wellbeing, resilience, or ability to continue caring.

Think about emotional, physical, or practical benefits.

Give Examples

Will it reduce stress, improve your health, give you time to rest, or help you stay socially connected?

Will it make everyday tasks easier so you can manage caring more effectively?

The more detail you are able to provide us with, the better equipped we will be to make a decision on your application

Are you new to Carers Gateway?*

Yes

No

Unsure

Already registered with you

Would you like to register for support in your caring role?*

Yes

No

Would you like someone to contact you about further information / advice / support to help you in your caring role?*

Yes

No

How would you like us to contact you about any aspects of your Time to Live application*

In order to speed up payment if your application is successful, please enter your bank details

Bank name*

Account Name*

Account Number*

Sort Code*

Is the information provided correct and accurate?*

I agree that the information I have provided is correct and I consent to Carers Gateway storing my information for the purpose of this application.

Did you have any help to complete this application?*

By applying for Time To Live funding, I agree to completing a Short Break Evaluation. Short break evaluation helps Carers Gateway and Shared Care Scotland evidence that short breaks improve carers’ wellbeing and sustain caring relationships*

Yes

Date of Application*