Reach Bursary application form

Information about you

Everyone should fill in this section of the form. This information tells us whether you are eligible to apply for a Reach Bursary award (aged 0-25 with an upper limb difference and living in the UK, Ireland, Isle of Man or Channel Islands).
Please note that we need your parent or carer's name and contact details if you are under 18.

1.1. What is your name?

2. What is your date of birth?

3. Full postal address?

4. Email address?

5. Nature of your upper limb difference?

6. Nature of any other relevant disabilities or long-term health conditions

7. Please upload a note(s) from a qualified health professional to confirm your limb difference and any other relevant disability.

8. Are you aged 18 to 25?

YesNo

Parents/Carers

9. Parent/carer's full name

10. Parent/carer's full postal address

11. Parent/carer's email address

Previous Bursary History

12. Have you received an award from the Reach Bursary Scheme in the past five years?

YesNo

13. Please provide details of your previous Reach Bursary Award. Please note that the Reach Bursary Scheme is limited to one application per year per individual; and a maximum of three awards, or awards totalling £5,000, in any five year period.

This Bursary details

14. Which of the following are you applying for support with?

Specialist equipment or adaptations necessary because of my upper limb differenceAdditional training necessary because of my upper limb differenceOther support necessary because of my upper limb difference

APPLICATIONS FOR SPECIALIST EQUIPMENT AND ADAPTATIONS.

This section of the form relates to specialist equipment or adaptations necessary because of your upper limb difference. We are looking for information that explains what the equipment/adaptation is, why you need it, what it costs. We also need an assessment from a healthcare professional to confirm that they have assessed this is the most appropriate equipment or adaptation for you, given your particular limb difference.

Individuals may only make one application in each 12 month period, and a maximum of three applications, up to a total value of £5,000, over a five year period.

15. Please provide a short (1-3 sentence) factual explanation of what equipment or adaptation you need.

16. Please describe why this equipment or adaptation is necessary because of your upper limb difference.

17. How much does this equipment or adaptation cost? Please provide an exact cost.

18. Are you able to contribute to the total cost of this equipment/adaptation and, if so, how much? Please note that being able to contribute is not a requirement of receiving a Reach Bursary award, but we have upper limits on how much we can award to any individual.

19. Please upload an assessment(s) from an independent healthcare professional(s) to confirm that the proposed equipment or adaptation is NECESSARY as a result of your limb difference; the MOST APPROPRIATE way to remove or reduce barriers for you, taking account of your limb difference and any other disability and/or long-term health condition; and NOT AVAILABLE through publicly-funded health or social services. This assessment should include the assessor's professional contact details in case the specialists on the Bursary Panel wish to seek further information to satisfy the Panel that the proposed equipment or adaptation are appropriate for your limb difference.

20. If this equipment or adaptation is necessary to enable you to participate in a specialist activity (e.g. sport, music), please upload a short note from an appropriate professional in that area to confirm that you are actively engaged in that activity. [There is no need for this in relation to car adaptations for normal day-to-day driving.]

21. Is there anything else you want to say in support of your application?

22. Are there any other supporting documents you want to provide in support of your application?

APPLICATIONS TO FUND ADDITIONAL TRAINING

This section of the form relates to additional training that is necessary because of your upper limb difference in order to enable you to participate fully in an activity that people without limb differences can access without additional training. In the form, we use the terms 'main activity' and 'additional training' to distinguish between the thing you want to be able to participate in and the extra training that you need in as a result of your upper limb difference.

We are looking for information that explains what the additional training is, why you need it in order to participate in the main activity, how long you need it for, and what it costs. We also need an assessment from an independent professional to confirm that you need this additional training because of your limb difference and, where the main activity is a paid activity, we need to know that you are able to cover the cost of that main activity yourself.

Individuals may only make one application in each 12 month period, and a maximum of three applications, up to a total value of £5,000, over a five year period.

23. What is the main activity that you want to participate in and for which you need additional training because of your limb difference?

24. What is the additional training that you need as a result of your limb difference in order to participate in that main activity?

25. Please explain why this additional training is necessary as a result of your upper limb difference in order for you to participate in the main activity.

26. How long will you need this additional training for in order to participate fully in the main activity?

27. What is the cost of the additional training? Please do not include the cost of the main activity in this figure.

28. Are you able to contribute to the cost of the additional training and, if so, how much?

29. Please confirm that you are able to fund the cost of the main activity.

YesNo

30. Please upload an assessment from an independent professional confirming that you need this additional training as a direct result of your upper limb difference, in order to participate in the main activity. The statement should also confirm that you are committed to participating in the main activity, and should provide the assessor's professional contact details in case the Bursary Panel needs to see further details.

31. Is there anything else you want to say in support of your application?

32. Is there any other supporting documentation you would like to submit in support of your application?

OTHER APPLICATIONS

While we expect that most people will apply for support in purchasing equipment or adaptations or to fund additional training that is necessary because of their upper limb difference, we recognise there may be other reasons why someone has a particular need for support as a result of their upper limb difference.

The questions in this section are to provide the Bursary Panel with information about what it is that you need support with and how this relates to overcoming barriers that arise as a result of your limb difference. The Panel will be looking for evidence to explain why this thing will be of extra benefit to you because of your upper limb difference, compared to the benefit that a child or young person without a limb difference might get from it.

Individuals may only make one application in each 12 month period, and a maximum of three applications, up to a total value of £5,000, over a five year period.

33. What is the thing that you are looking for support with?

34. How does this relate to your upper limb difference?

35. Please explain for the Panel why this would be of extra benefit for you, because of your upper limb difference, compared to the benefit that a child or young person without a limb difference might get from it.

36. Please upload an assessment from an independent professional explaining why this is necessary as a result of your upper limb difference and why it will be of extra benefit for you because of you limb difference, compared to the benefit that a child or young person without a limb difference might get from it. The assessment should include the assessor's name and contact details in case the Bursary Panel wishes to seek further information.

37. Is there anything else you want to say in support of your application?

38. Is there any additional documentation you would like to submit in support of your application?

CONSENT

Data protection law requires that we have your consent to process your data - in this case, this means to consider your application and make any award. We also need to account for the awards in our Annual Report, though this can be done anonymously. If you do not consent, we are unable to consider your application. Our usual practice is to retain bursary applications for five years after an award is made - this is because there are restrictions on the number of times people can apply for bursary awards and the overall total of awards they can receive in a period of five years. Our privacy policy are available on our website.

Additionally, we would love to be able to publicise any award you receive to help spread the word about the benefits of the Reach bursary scheme in our social media and other outreach materials. You are not obliged to consent to this, but we would greatly appreciate it if you would be willing to allow this. We will agree the text and any photograph with you before using it publicly.

39. I consent to Reach processing my personal data for the purposes of considering my application for a Reach Bursary award.

YesNo, and I understand this means that my application cannot be considered.

40. I consent to Reach publicising any award I may receive as a result of this application.

Yes, I am happy to agree to this and note that Reach will agree the text and any photograph with me before it is used.No, I consent only to having any award mentioned anonymously in the charity's Annual Report

Please read the Terms and conditions below before submitting.

Terms and Conditions

1. The Bursary Panels decision is final.

2. The Bursary panel meet 4 times per year and decisions will be made then

3. Please ensure you submit your application at least 2 weeks prior to the dates listed on the website for your application to be considered at that meeting.

4. When submitting your application, please ensure you state the exact cost you require and justify your reasonings.

5. Successful applicants will be expected to report back to Reach immediately the grant has been spent, please supply a progress report and photos to celebrate and help promote the bursary to other members.

6. Grants will usually be paid by cheque, BACS, or a 3rd party via invoice. Proof of expenditure will be required.

7. It is unlikely that 100% of the amount request will be awarded, please ensure you can meet the remainder of the costs and explain how in section 4.

8. The grant should usually be spent within 6 months of receipt.

9. The grant is not transferrable and must be used for the purpose stated in the application.

10. Publicity is not a requirement of the grant but applicants who are happy for Reach to use them in publicity or undertake their own publicity mentioning Reach are very welcome.

11. The Bursary Panel may direct applications to other grant giving bodies if they are deemed to be more suitable.

12. Applications are only accepted from current members of Reach, with at least 1 year’s membership.

13. Thank you for applying, please send your completed form to the address below or email to reach@reach.org.uk

I have read the Terms and Conditions and accept

Contact Information