Grant Application

Personal Details

Address

Injury Details

Complete or Incomplete

Equipment / Grant Request

Applicants can request a maximum of 75% of the costs of the equipment, up to a maximum of £5,000. The Grants Panel can advise of other organisations that applicants can approach, or Regain can provide advice with fundraising activities in the applicants local community.

Have you tried obtaining the Equipment or part funding from any other source?
e.g. NHS Wheelchair Services, Social Services, Local Health Authority, Motability or other Charity or Trust etc...

Application Support

Please provide the contact details of either your consultant, occupational therapist, case manager, physiotherapist, care manager or if appropriate, a relative who we can contact to verify that the equipment requested is suitable.

Support Address
Signature of Applicant
Can you make a contribution towards the cost of this equipment ?
(We do expect ALL applicants to contribute towards the cost)
Have you provided 2 quotes from supplies plus supplier details ?

Financial

Have you received a compensation claim ?
Have you a compensation claim pending?
Are you in receipt of PIP ?
Do you own your own home?
Do you own,control or have access to other significant assets?
e.g. property, shares, private pension, etc.
Stay up-to-date with what's happening
Regain is working in partnership with Aspire, who also operate a grants scheme for items such as power assisted add ons and some wheelchairs.
Personal Data Consent