Section C. About Your Link with the Family

Marvellous Family Grants
Application Form
Part Two: MAIN FORM
This form must only be completed and submitted by an employee of a statutory agency or registered charity, not by a member of the family involved. Please write very clearly and answer every question.
Before you begin, please ensure you have read the Application Guidance document which details all the information you will need to make an application and ensure you have this available before you start. Please ensure you complete every section of the form including the bank account details. Any incomplete forms will automatically be discarded.
If your charity’s annual turnover is over £1 million and/or your charity has been registered for less than 2 years, then we are unable to accept your application.
Case no:

SECTION A. ABOUT THE APPLICANT OFFICER[1]

A1. Name
A2. Job Title
A3. Name of your Organisation
A4. Your office address
A5. Address line 2
A6. Town/City
A7. County
A8. Post Code
A9. Telephone No.
A10. Email Address

SECTION B. ABOUT THE FAMILY

Surname / First Name / D.O.B / Gender
B1. Child/Children with serious illness
B2. Siblings
B4. Parent-carer 1 / -
B5. Parent-carer 2 / -

SECTION C. ABOUT YOUR LINK WITH THE FAMILY

C1. How long have you known the family? / To you personally?
To your organisation?
C2. In what capacity do you know the family?

SECTION D. THE FAMILY’S CONTACT DETAILS

If the application is successful, then we will use these details to contact the family to complete a feedback form.

D1. Address
D2. Address line 2
D3. Town/City
D4. County
D5. Postcode
D6 Contact Number
D7. E-mail
D8. Would you be happy for us to contact you via e-mail to complete a feedback form? / Yes / No

SECTION E. MEDICAL CONDITION

E1. What medical condition has been given to the child/children (state ‘undiagnosed’ if relevant)
Name of child:
Name of child:
Name of child:

SECTION F. THE SUPPORT REQUESTED

Please note that the funding is to benefit the child/children with the serious illness.

F1. What specific supportare you applying for? / Please describe this in two to three sentences.
F2. How will this support benefit the child/children with the serious illness? / Please describe this in two to three sentences.
F3. What is total cost of this support? / Please provide a breakdown of costs.Please note that the total cost might exceed the grant requested.
F4. What is the value of the grant that you are requesting? / This must be £500 or less, even if the total cost of the support exceeds £500
F5. Please explain why the costs of this support cannot be covered by:
(a) the family themselves?
(b) statutory sources?
F6. Have you applied to any other charities/organisations? If so, which ones and could they help? If not, why not?
F7. If you are a charitable organisation,please state your registered charity number, what your charity’s annual turnover is, and how long your charity has been registered for. This can be found on the Charity Commission website.
Please note that if your charity’s annual turnover is over £1 million and/or the charity has been registered for less than 2 years then we will be unable to accept your application.

SECTION G. PAYMENT TO YOUR ORGANISATION

If your application is successful, then we will transfer the funds to your organisation’s bank account. Please note that we cannot pay individuals.

Please double check that you have provided the exact, correct account details.

G1. Bank or Building Society Name
G2. Account Name
G3. Sort Code: / This must be in the following format: 12-34-56
G4. Account Number / This will be 8 digits long.

SECTION H. EVIDENCE TO SUPPORT THE APPLICATION

H1. Have you met with the family? / Yes / No
H2. Which of the following is the child/children with the serious illness in receipt of?
Medium Rate DLA / High Rate DLA / Enhanced rate for 6 of the 12 activities in the PIP
H3. If the family have not applied for DLA/PIP, please tell us the reason why:
H4. In your opinion, is the family living in financial hardship? / Yes / No

SECTION I. AGREEMENTS

Roald Dahl’s Marvellous Children’s Charity requires agreement to its Terms and Conditions before it can consider applications to its Marvellous Family Grants fund.

Please read the Terms and Conditions below. If you have understood and agree to be bound by our Terms and Conditions, sign the declaration at the end of the Application Form before submitting it to us. If you have any questions, please contact us by telephone: 01494 890 465 or email:

Terms and Conditions

As the Applicant Officer (“AO”), you must agree to be bound by the Terms and Conditions below for your application to be processed by Roald Dahl’s Marvellous Children’s Charity (“the charity”):

The information I have provided on the application form is, to the best of my knowledge, accurate and true.
The full grant amount must be used as specified in the application form and for no other purpose. I understand that the charity will investigate any allegations of misuse of grants awarded or fraud and will prosecute if there is sufficient evidence to prove that fraud has been committed.
By agreeing to the charity’s terms and conditions, I take responsibility for ensuring that the grant received from the charity is spent on the item(s) specified in the application form. Failure to do so will result in the charity claiming full reimbursement.
I agree that I will comply with any specific terms and conditions that the charity notifies me of in relation to specific grants.
I take responsibility for ensuring that the Marvellous Family Grant monies are presented to beneficiary families for use within three months of their date of issue. Failure to do so will result in the grant being withdrawn by the charity. If an unforeseen problem arises which prevents use of the grant within three months, I must ensure that the monies are returned to the charity for reissue, within three months of the original date of issue.

Any third-party organisation providing duties that bring them into contact with the beneficiary family in receipt of grant funding must have a full Disclosure and Barring Service (DBS) check (England and Wales), a Protecting Vulnerable Groups (PVG) Scheme Membership Statement (Scotland), or Enhanced Disclosure (Northern Ireland). I take responsibility for ensuring these checks are in place.
I understand that help from the charity is discretionary and subject to funds available. There is no entitlement to a grant and all applications are assessed on a case by case basis at monthly allocation meetings.
I understand that the charity can only consider one application per family per year.
I agree that these terms and conditions are governed by UK law and that the courts in the UK have jurisdiction to hear disputes between us.
By signing, I confirm that I have read, understood and agree to be bound by the terms and conditions set out above.

“The information on this form is correct to the best of my knowledge. I support this application and believe it to be consistent with the principles of the Marvellous Family Grants. I confirm that my organisation will process the grant efficiently and effectively, in line with the statements on this application form”

AO signature / Date:

“I confirm that the information on this form is correct to the best of my knowledge. I agree to use the grant to access the support as outlined on this form. I agree that Roald Dahl’s Marvellous Children’s Charity may contact me directly to evaluate the usefulness of the support that my family has received. I agree to my data being stored, processed, analysed and evaluated by Roald Dahl’s Marvellous Children’s Charity. Roald Dahl’s Marvellous Children’s Charity will treat my data in strict confidence and will never pass it to anyone else.”

Parent/Carer signature / Date:

Please continue to page 6 to complete the appendix.

APPENDIX. MONITORING

We actively monitor our grants to ensure they are reaching all members of the community.

Please note that this will not be used in determining whether a grant is successful.

This appendix will be removed before the application is considered.

How does the family describe the ethnicity of the child/children with the serious illness?
Arab / Black British / White and Asian
Asian Bangladeshi / Black Caribbean / White and Black African
Asian Chinese / Other Black / White & Black Caribbean
Asian Indian / Gypsy or Irish Traveller / White British
Asian Pakistani / Other Ethnic Group / White Irish
Other Asian / Other Mixed
Black African / Other White

Please return form to:The ProgrammesOfficer, Roald Dahl’s Marvellous Children’s Charity, Montague House, 23 Woodside Road, Amersham, HP6 6AA, or by e-mail to:

[1] Applications to the Marvellous Family Grants fund are only accepted when they have been completed and submitted by an employee of a statutory agency or registered charity. Employees who are eligible to apply are referred to as Applicant Officers and may be a social worker, health visitor, healthcare professional, family worker, or similar professional.