Reach Membership application form

Information about you

Everyone should fill in this section of the form. Please note that in 2024 the membership Bursary form if for families whose Reach Children are age 10-18yrs only and living in the UK, Ireland, Isle of Man or Channel Islands).

Parents/Carers

Parent/carer's full name

Parent/carer's full postal address

Parent/carer's email address

Is your Reach child aged 0-18 and living in the UK, Ireland, Isle of Man or Channel Islands

YesNo

Details of your Reach Child/Young person

1.Childs Name?

Date of birth?

Full postal address?

Nature of upper limb difference?

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

Previous Bursary History

Have you/your family received an award from a Reach Bursary Scheme in the past five years?

YesNo

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

Can you contribute any funds to your membership?

YesNo

If yes, Please let us know how much.

As part of the application process, we would also like to understand why becoming a member is important for you as a family/Reach member at this time. Please write a summary here

APPLICATION

Families 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.

Please could you upload your most recent benefit entitlement. This can be a letter or a screenshot, showing the name of your family’s main carer, and current address.

Is there anything else you want to say 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.

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.

Contact Information