The Chronicle Sunshine Fund
Equipment Request Form
Registered Charity 1133293
This form is for both organisations and individuals to apply to The Chronicle Sunshine Fund, please read our guidelines before applying.
1. Name of individual/organisation applying:(Parent, guardian, carer etc)
2. Address:
3. Email address:
Please note, all correspondence will be made by email.
4. Home/work number: 5. Mobile number:
6. Name of child: 7. Date of birth:
8. Health diagnosis/health problems:
9. Beneficiary’s/guardians details:
Name:
Address:
(If different to above)
10. Email address:
Please note, all correspondence will be made by email.
11. Home/work number: 12. Mobile number:
13. The Equipment Required:
(make and model and description, please note that we are not responsible for the equipment).
14. The Benefits:
(We want to know how this equipment will help the child)
Who identified the need for this equipment, or did an assessment?
Why is it important to have the equipment at this time/age?
Please describe exactly how and why this equipment will make a difference to the child? (Independence, improving physical ability, developing social skills, etc. Organisations need to tell us how many children will benefit. Individuals should tell us about their family circumstances).
How will it also make a difference to the family?
Who will provide training on how to use the equipment?
Please explain why statutory agencies cannot fund this equipment?
15. Total cost / £
*Cost excluding VAT / £
Amount raised/secured to-date by other means / £
Total amount needed for equipment / £
Please note if the equipment that you are requesting is specialised equipment for people with disabilities, then the equipment is exempt from VAT.
16. Please tell us about other charitable funding organisations that you have applied to regarding this piece of equipment:
17. Payment Details - IMPORTANT
Name of supplier:
(Please provide BACS details as the payment will be made directly to the supplier electronically, we need this information to be able to make the payment).
Sort code:
Account Number:
18. Where did you hear about the Evening Chronicle Sunshine Fund?
19. Print Name: / 20. Signature:
Checklist - please make sure you have enclosed the following: /
A fully completed Equipment Request Form
Two quotations from recognised suppliers for the equipment
Two Letters of Support
Payment details
21. If your application is successful, would you agree to a photo and story in The Evening Chronicle?
(This would help the Sunshine Fund by raising awareness of the charity so we can help many more children in the North East with disabilities).
22. Additional information:
Applications should be sent to:
Julieanne Kelly
Office Manager
The Chronicle Sunshine Fund
Groat Market
Newcastle upon Tyne
NE1 1ED
Or email
If you have any questions about your application please contact the office: 0191 2016090
The Chronicle Sunshine Fund is not responsible for the maintenance and/or ownership of any equipment. The equipment is the responsibility of the organisation or the individual applying.