About you
I am a making an application *
----
For my family as a parent/guardian
On behalf of a family
I am a *
----
Social Worker
Clinical Nurse Specialist
Other
Your title *
----
Mr
Mrs
Miss
Ms
Dr
Professor
Other
Your first name *
Your last name *
Your healthcare institution/organisation *
Your email *
Your telephone number *
Your address *
Please tell us how you are related to your child or young person? *
How did you hear about the bereavement grant? *
Has an application for a bereavement grant previously been made by, or on behalf of the family? *
----
Yes
No
Unsure
About the child or young person
About your child or young person
Child or young person's first name *
Child or young person's last name *
Their gender
Their date of birth *
Their date of passing *
About your child or young person's Clinical Nurse Specialist
About the parent/guardian
Parent/guardian first name *
Parent/guardian last name *
Their email *
Their address *
Nurse first name *
Nurse last name *
Their institution *
Their email
About the grant
Please tell us how the grant will be used by the family *
Please tell us how the grant will support your family *
How much (£) is being requested (up to £500)? *
Bank details
Account holder name (as it appears on the bank account) *
Bank name *
Account number *
Sort code *
Please confirm how the account holder is related to the child or young person *
Confirmation of eligibility criteria
Please confirm your family meets the following eligibility criteria:
Confirmation of eligibility criteria
Please confirm the family meets the following eligibility criteria:
The child or young person had a neuroblastoma diagnosis
*
My child or young person had a neuroblastoma diagnosis
*
The child or young person was 30 years or under when they passed away
*
My child or young person was 30 years or under when they passed away
*
My child or young person passed away less than one year ago
*
The child or young person passed away less than one year ago
*
The family is residing in the UK or Ireland
*
My family is residing in the UK or Ireland
*
Please upload formal confirmation of the child/young person’s passing, including the date of passing *
Declarations
Please read and agree to the following statements:
Can we keep in touch with you?
We will tell you about how we’re driving change for families affected by neuroblastoma through our research, support, and awareness work as well as about different fundraising events and initiatives including our children’s campaigns for access to treatment. We will always keep your details safe and will never share them with other organisations for their own marketing purposes. You can change your preferences or opt-out of communications at any time by using the unsubscribe link in our emails or by contacting us at info@solvingkidscancer.org.uk.
Can we keep in touch with you?
We may use the preferences you select to let you know about our work, including across support, research and awareness. We will always keep your details safe and will never share them with other organisations for their own marketing purposes. You can change your preferences or opt-out of communications at any time by using the unsubscribe link in our emails or by contacting us at info@solvingkidscancer.org.uk.
By email
By text
By phone
