Apply for a Grant

Primary Contact Details

This section is about the person who holds parental responsibility and lives with the child

Title

First name

Surname

Your relationship to the child you are applying for

Address line 1

Address line 2

Town / City

County

Postcode

Daytime telephone

Mobile

Email

Do you have any communication needs?

Yes

No

if YES, please explain:

Child Details

Please tell us about the child you are applying for

Gender

Male

Female

First name(s)

Surname

Birth date

Siblings (please add more rows as required)

Name	Age

Cancer diagnosis

Stage of treatment

Main Consultant(s) name

Social worker name (if applicable)

Consultant / Social worker contact number

Treatment hospital(s)

Time since initial diagnosis

Grant Details

Reason(s) for the grant application

Please provide details

Have you received a previous grant from My Shining Star?

Yes

No

If YES, what date was it awarded

Financial Details

We need to know about the money you receive into your home. Please confirm with bank statements less than 3 months old

What will you use the grant for?

Household savings

£

Household income

£

Do you claim benefits?

Yes

No

If YES, please specify

You must attach evidence to accompany your application. This might be bills for payment, receipts, bank statements, a consultant letter, a letter from the DWP etc. Please include anything that you think might be relevant to your application.

You can upload PDFs, office documents and photos. If you do not have access to a scanner, you can take photos with your phone and upload those. Each file must be uploaded one at a time (click the upload button as many times as you need)

File upload(s)

Upload File

Payment Details

If the grant is awarded, where should it be paid to?

Bank name

Account holder name

Sort code

Account number

Data Protection and Publicity

By submitting this form, you agree to us:

recording your details on a database, to help provide us with useful data about the applications we receive;
publishing your details in our yearly accounts required for the Charity Commission purposes

We may also contact you from time to time by phone, email, text or post to tell you about how we can support you. Your details will be kept securely and only shared with our suppliers or partners who work on our behalf or with us to deliver and improve services for people affected by cancer. We never sell or swap your details with third parties.

Are you happy for us to use your information in this way?

Yes

No

We are a small organisation with no access to government funds. Can we use your story / image to raise awareness and encourage others to fundraise?

Yes

No

I confirm that the information on this application is true and accurate and that I have read and agree with the terms and conditions outlined in the application guidelines document.

Before clicking the button below please ensure that you have fully completed the form and have uploaded sufficient evidence (bill for payment, receipt, bank statment, proof of benefit, consultant letter etc) to back up your application.

Apply online for financial help