Holiday Grant Form - The 3H Foundation

Introduction/Eligibilty

How did you hear about us?

Please select where you live/applicable category.

Have you lived in the UK for 6 months or more?

Are you on a means tested benefit (Universal Credit or Pension Credit) with no unexplained income?

Do you have £3000 or more in combined savings in any bank or building society account?

Is the applicant in receipt of DLA/PIP/AA?

Does the person with the disability meet the 'definition of disability' from the Equality Act?

The definition of disability means: 'A physical or mental impairment that has a substantial and long-term effect on your ability to do normal daily activities.' Note:'Substantial' means more than minor or trivial, e.g. It takes longer than usual to get dressed. Long-term means for 2 months or more. e.g. a breathing condition that develops as a result of a lung infection.

How many additional family members attending the holiday have a disability?

Have you received a holiday or carer grant from The 3H Foundation before?

If Yes, when was this? (i.e. the year).

What year did you last have a holiday/break of one night away or more (i.e. the year).

Are you a wheelchair user due to a physical disability?

Disability evidence will be requested at the next stage, such as a letter from a doctor, hospital, social worker or some other medical professional dated within the last 12 months.

Please list the main diagnosed disabilities

SECTION A: Your Situation

Please provide more information on how your disability affects your everyday life, including the main challenges you are facing at present and how a holiday grant would be of benefit to your familiy.

Section B: Applicant Details

Details of the person with the disability.

Title

First Name

Last Name

Age

Date of Birth

Address Line 1

Address Line 2 (optional)

Town

County

Post Code

Home Telephone Number

Mobile Telephone Number

Email Address

Details of contact if different to above.

Title

First Name

LastName

Relationship to the person with the disability

Home Telephone Number

Mobile Telephone Number

Email Address

Section C: Household Details

How many people live in your household?

Please list everyone who is living in the household.

Name

Age

Relationship

Employment/Education Status

Name

Age

Relationship

Employment/Education Status

Name

Age

Relationship

Employment/Education Status

Name

Age

Relationship

Employment/Education Status

Details of further additional household members.

SECTION D: Proposed Holiday

Please note that grants are only for the ACCOMODATION part of a holiday and are awarded for household family members and, if necessary, a carer attending the holiday. Payment is made directly to the holiday venue/organisation by bank transfer. We will NOT pay grants directly to applicants.

Month of proposed holiday (if known).

Please list everyone going on holiday

Name

Address

Relationship

Name

Address

Relationship

Name

Address

Relationship

Name

Address

Relationship

Details of further additional household members going on the holiday.

SECTION E: Income Details

Please write in the weekly/monthly amount you receive for each benefit/source of income. Please include amounts for ALL household members that receive benefits/income. If no benefit is received, please put in '0'.

Universal Credit (Before deductions)

Per week or month?

Disability Living Allowance/PIP/AA

Per week or month?

Carer's Allowance

Per week or month?

Salary

Per week or month?

Employment and Support Allowance (ESA)

Per week or month?

Housing Benefit (If not already in your UC figure)

Per week or month?

State Pension

Per week or month?

Pension Credit

Per week or month?

Child Benefit

Per week or month?

Maintenance

Per week or month?

Other Income/Benefits

Per week or month?

Please add any other low-income information you wish to tell us about.

If we are able to proceed, evidence of all your benefits and 1 months bank statement.

PLEASE NOTE THAT IF YOU HAVE ALREADY BOOKED AND PAID FOR A HOLIDAY, WE WILL NOT BE ABLE TO AWARD YOU A GRANT. tHE GRANTS THAT WE OFFER ARE MODEST GRANTS BETWEEN £250 and £550.

DECLARATION

I confirm the information provided in this application is true and complete and I agree to The 3H Foundation's terms and conditions. These can be found on our website or requested separately.

Yes

I understand that providing false or misleading information may result in my application being automatically rejected.

Yes

I consent to data processing under the Data Protection Act 2018.

Yes

I agree to complete a post holiday questionnaire.

Yes

I consent to anonymised feedback being used for reporting and promotion.

Yes

We’ll use the contact details you provide during your application to send you updates about our charitable activities. You can opt out anytime.

Yes

Signed

Date

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Holiday Grants Application Form

Introduction/Eligibilty

SECTION A: Your Situation

Section B: Applicant Details

Section C: Household Details

SECTION D: Proposed Holiday

SECTION E: Income Details

DECLARATION