General Grant Application Form

Version: 1.0 | Effective from: August 2026 | Review date: August 2027

Welcome

Thank you for your interest in applying to Make Them Smile Children's Trust.

We understand that caring for a child with a disability, serious medical condition or additional needs can be challenging, both emotionally and financially. Our aim is to provide practical support that improves the quality of life for children and their families.

Every application is considered individually by our trustees. We assess each request on its own merits, taking into account the child's needs, the expected benefit of the support requested, the family's circumstances and the charity's available funds.

Our trustees are committed to ensuring that every application is considered fairly, respectfully and confidentially.

Before You Begin

Before completing this application, please ensure you have the following available where applicable:

Medical evidence confirming the child's condition or additional needs.
Details of the support or equipment being requested.
A quotation or estimate for the item or service, where available.
Proof of household income or benefits.
Three months of recent bank statements.
Details of any professionals involved in the child's care.
Permission from the parent or legal guardian if completing this form on behalf of a family.

Completing this Form

Please complete every relevant section as fully as possible. If a question does not apply, enter “Not Applicable” or “N/A”. Incomplete applications may be delayed while further information is requested. Submission does not guarantee that funding will be awarded.

Sections

Applicant Information
Child's Details
Support Requested
Medical Information
Family Circumstances
Financial Information
Checklist Before Submission
Declaration

Section 2 – Child's Details

Please provide details about the child or young person for whom support is being requested.

Child's Full Name

Date of Birth

Home AddressComplete if different from the applicant's correspondence address.

Postcode

Does the child live at this address permanently?

Yes No

If no, please provide details

NHS Number (if known)

Name of GP Surgery

Name of Hospital or Hospitals Attended

Consultant or Lead Healthcare Professional

School, Nursery or Educational Setting (if applicable)

Does the child have an Education, Health and Care Plan (EHCP)?

Yes No Assessment in progress Not applicable

Does the child currently receive Disability Living Allowance (DLA) or Personal Independence Payment (PIP)?

Yes No Application pending

Section 3 – Support Requested

Please tell us about the support you are requesting and how it will benefit the child or young person.

What support are you applying for?Please describe the equipment, service or assistance being requested.

What is the total cost of the item(s), equipment or support requested?

Who will be supplying the equipment or service? (If known)

Please explain why this support is needed.

How will this support improve the child's quality of life, independence, wellbeing or safety?

Has funding been requested from any other organisation for this item or service?

Yes No

Organisation

Amount requested (£)

Outcome (if known)

Is this request urgent?

Yes No

If yes, please explain why

Has the child previously used or trialled this equipment or service?

Yes No Not applicable

If yes, please provide details

Section 4 – Medical Information

Please provide details of the child or young person's medical conditions, disabilities or additional needs.

Please list the child's diagnosed medical conditions, disabilities or additional needs.

How do these conditions affect the child's daily life?For example, communication, mobility, personal care, learning, behaviour, safety, sleep or social interaction.

Please tell us about any professionals currently involved in the child's care.For example, Consultant, GP, Occupational Therapist, Physiotherapist, Speech and Language Therapist, Community Nurse, Social Worker, Hospice, or other professionals.

Is the child currently receiving any therapies or specialist support?

Yes No

If yes, please provide details

Are there any risks to the child's health, safety or wellbeing if this support is not provided?

Yes No

If yes, please explain

Please provide any additional information you feel would help the trustees understand the child's needs.

Section 5 – Family Circumstances

Please tell us about your family's circumstances.

Who lives in the family home?Please include parents, guardians, siblings and anyone else living at the address.

Please tell us about your family's current circumstances.For example, caring responsibilities, financial pressures, housing, employment, transport, or any other factors you feel are relevant.

Please explain why this support cannot be funded by your family without assistance from Make Them Smile Children's Trust.This may include caring responsibilities, reduced income, increased household costs, travel expenses, specialist equipment, or other factors affecting your family's ability to meet this cost.

Have you previously received support from Make Them Smile Children's Trust?

Yes No

If yes, please provide brief details (if known)

Is there anything else you would like the trustees to know when considering your application?

Section 6 – Financial Information

We appreciate that discussing finances can be difficult. This information helps our trustees ensure that limited charitable funds are distributed fairly and to families most in need. All information is treated in the strictest confidence and used only to assess this application.

Please provide details of your total household income.Include all income received by every adult living in the household, including employment, self-employment, pensions, Universal Credit, Child Benefit, DLA, PIP, Carer's Allowance, maintenance payments, tax credits and any other regular income. State whether each amount is weekly, four-weekly, monthly or annually.

Is anyone in your household currently receiving benefits?

Yes No

If yes, please list the benefits received

Total monthly household outgoings (£)Include mortgage or rent, council tax, utility bills, food, travel, insurance, childcare, loan repayments and any other regular household commitments.

If there are any unusually high or exceptional expenses relating to the child's care, please provide details.

Are there any exceptional financial commitments or additional costs relating to the child's care that you would like the trustees to consider?For example, frequent hospital travel, specialist diets, therapies, additional heating, equipment or adaptations.

Supporting Financial Documents Upload three months' recent bank statements, proof of earnings, benefit statements and any other relevant financial evidence. You may select several files.

Accepted: PDF, JPG, PNG, DOC and DOCX. Maximum 10 MB per file and 40 MB in total.

Section 7 – Checklist Before Submission

Please ensure all relevant sections are complete and supporting documents are attached where applicable.

I have completed:

All relevant sections of this application form. I will complete the declaration below.

I have enclosed (where applicable):

Medical evidence confirming the child's condition. Quotation(s) or estimate(s). Three months' recent bank statements. Proof of income and/or benefits. Professional reports or assessments. Any other supporting information.

Is there anything you have been unable to provide at this stage?

Other Supporting DocumentsUpload medical evidence, quotations, trial reports, assessments or other relevant documents. You may select several files.

Accepted: PDF, JPG, PNG, DOC and DOCX. Maximum 10 MB per file and 40 MB in total.

Section 8 – Declaration

I confirm that, to the best of my knowledge, the information provided in this application is complete and accurate.

I understand that Make Them Smile Children's Trust may request further information or supporting documents; may contact the applicant, parent or legal guardian and relevant professionals where permission has been provided; may decline the application or withdraw support if false, misleading or incomplete information is provided; and may purchase equipment or services directly from the supplier. Submission does not guarantee funding, and the trustees' decision will be final.

Data Protection

I understand that the personal, financial and medical information provided will be used to assess and administer this request, stored securely, handled in accordance with UK data protection legislation and the charity's Privacy Policy, and shared only where necessary, where permission has been given, or where legally required.

I confirm that I have read and understood the declaration above. I consent to Make Them Smile Children's Trust using the information provided to assess and administer this application.

Applicant's Full Name

Electronic SignatureType your full name.

Date

Fields marked with * are required. Do not close this page while files are uploading.

Welcome

Before You Begin

Completing this Form

Sections

Section 1 – Applicant Information

Section 2 – Child's Details

Section 3 – Support Requested

Section 4 – Medical Information

Section 5 – Family Circumstances

Section 6 – Financial Information

Section 7 – Checklist Before Submission

Section 8 – Declaration

Data Protection

Parent or Legal Guardian's Consent