Support Grant Application Form

Contact Us

For any help filling out the Support Grant application form, please contact the Helpline at:

Telephone: 0300 0110 122

Email: helpline@pspassociation.org.uk

Step 1 of 4

GUIDANCE NOTES

PSPA support grants are provided to make a difference to those living with or affected by PSP & CBD and to help improve quality of life. Applicant must be resident in the UK.

Funding is limited and applications will be assessed based on the impact that the item or service would have on the person living with PSP, CBD and/or their carer. We are only able to provide a grant to an individual once a year. Please note that the maximum amount for a support grant is currently £300, we consider value for money and the impact of the grant and may award any amount up to the maximum. Please contact PSPA helpline on 0300 0110 122 or helpline@pspassociation.org.uk if you have any questions.

EXCLUSIONS

PSPA will not provide a grant in the following instances:

Retrospective funding
Emergency healthcare needs
Funeral costs
Repayment of debt
Legal fees
Daily living costs (including utilities).

We aim to process applications within 5 working days. Once a decision has been made, the applicant and the referring HSCP will be informed.

We require the following information when applying for funding before we can consider your application:

Completed application form. Incomplete application forms will result in the application being delayed whilst further information is requested.
All applications require assessment by an appropriate HSCP, i.e. an assessment by an Occupational Therapist recommending the exact make and model for mobility equipment such as wheelchairs, walking aids and specialist seating or Speech and Language Therapist for communication aids.
Quotation with the cost of the item.
Confirmation that funding is not available from statutory sources.

If you would like a hard copy of this form, please email the Helpline at: helpline@pspassociation.org.uk

Details of Person with PSP, CBD or Carer

Salutation:

Name: *

First

Last

Date of Diagnosis:

Date of Birth:

Ethnicity:

Gender: *

They are the: *

Home Phone

Mobile: *

Preferred Phone:

Preferred method of contact:

Email *

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Data Protection Statement

Has the person with PSP, CBD or Carer consented to this application, the sharing of their contact details and for PSPA to contact them by phone? *

PSPA will follow procedures for recording, storing, and updating personal information all of which will comply with the Data Protection Act 1998 and any subsequent legislation including the General Data Protection Regulation. We may occasionally share your information within the association and with local health and social care professionals where it helps with your care and support or with development of better services. If you have already expressed a preference for future contact we will follow these, if not, we may ask you for your views on how our services might be improved. If you do not want us to be in contact, please let us know on helpline@pspassociation.org.uk

Please see our privacy policy on our website www.pspassociation.org.uk for full details of how we use your information.

Signature of person with PSP, CBD or Carer (Professional can sign on person's behalf):

Clear Signature

Date:

Communication Preferences for Applicant

We greatly appreciate your support and would like to keep in contact with you about our news - including stories and information about our supporters, research projects, volunteering and fundraising activities and appeals.

If you are happy to hear from us with these updates, please tell us how you would like to be contacted (you can select more than one method):

Email
Post
Phone
I don't want further contact from PSPA*

*We will only contact you with regards to this application.

PSPA will use your personal information only for the purposes for which you have given us consent. We will keep your data confidential and safe, and will never swap or sell it and you can always withdraw your consent at any time by emailing consent@pspassociation.org.uk or calling 01327 322410.You can see our privacy statement which explains how we collect, store, manage and use your personal information at https://pspassociation.org.uk/home/privacy-policy

Custom Captcha *

Support Grant Application Form

Contact Us

GUIDANCE NOTES

EXCLUSIONS

Details of Person with PSP, CBD or Carer

Details of Professional Making the Application

Grant Details

Payment Details:

Statement by the Referring Professional

Data Protection Statement

Communication Preferences for Applicant