Financial Help

Firstly can we just say that we are sorry that you are here. There is nothing fair about the situation you are in and we are sending you a big Cwtsh.

The grant we offer is for a cost that you are struggling to pay for that has been caused by your cancer diagnosis. Our grant amount is £250 (one off payment if eligible).

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You are in Section 1 of 5

If you are age 15, 16 or 17 would you mind asking a parent, carer or guardian to fill in this form. (We know you can do it but it's just a legal thing.)

Your Email Address Your Name

Your Gender Male Female Non-Binary You Tell Us

Address Line 1 Address Line 2 Town / City Postcode Mobile Phone Number Date of Birth

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You are in Section 2 of 5

Tell us about yourself and why you are applying for this financial help. We will need as much information as possible about why this money is needed and how you would use it. What is your diagnosis/type of Cancer?

Please Tell Us:

What is the main hospital you are having treatment at?

Please Tell Us:

Is this your first diagnosis or have you relapsed? First Diagnosed I Have Relapsed

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You are in Section 3 of 5

We need to contact a referee to support your application

This person must be a member of your medical team, eg CNS/Consultant/Social Worker/Youth Worker

Do you give us your permission to contact this person and for them to confirm your diagnosis? Yes No

Sorry, we cannot award a grant without a reference from your medical team.

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You are in Section 4 of 5

What is your annual household income (before tax and outgoings)

How did you hear about the Sir Gareth Edwards Cancer Charity?

Please Tell Us:

Have you made any previous applications? Yes No

Are you happy for us to keep in touch? Yes No

Do you think that people who are going through Cancer Treatment get enough financial support? Yes No

What has been the hardest thing for you financially?

What needs to change so that you and your family feel more supported?

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You are in Section 5 of 5

Please provide your Bank Details which we will only use if your application is successful.

Your Bank Name Name on Your Account Sort Code (6 digits) Account Number (8 digits) Your Data

We will hold your data for no longer than necessary. You can request to have your data removed at any point.

Agree to our privacy notice

Previous Complete Application

Winking Owl

All done! Thank you for filling this in. We will now read your application and get in touch with your referee. If you are successful we will pay your grant straight into your bank account. Please take care and if you feel like tagging us on your Instagram we'd love to see you :)

Why not check out our Instagram?