Time for Carers Fund – Application Form
To apply for a Time for Carers grant please read the guidance notes and complete the form fully. Without accurate and complete information we may not be able to process your application. Guidance notes are indicated in an ‘orange’ font colour.
Section 6: For completion by the Agent supporting this application
Your application must be supported by an Agent who can verify your caring role before sending this form back to us. During the current lockdown, we can accept an email or letter from your agent. Please visit this page for email and address details.
If your supporting agent is not with you as you fill in this form - you may contact them and have them fill in a separate form on your behalf for this section. Please provide your supporting agent with this link: https://www.carersleeds.org.uk/t4c-agents/ and ask them to fill it in for you.
The Agent must be a health or social care professional who provides a service to the carer or person with care needs. For example, a GP or other doctor, a social worker, a nurse, an occupational therapist, a physiotherapist, home care worker, day centre worker or counselor. The Agent cannot be a relative, friend, work colleague or an employer.
We reserve the right to contact the Agent so that they can verify that the information on this application form is correct
As an Agent supporting a Time for Carers application you are signing to verify that, to your knowledge, details provided by the carer named on this application form are correct. You are also signing to confirm that the applicant named on this form is a carer or former carer who provides/provided necessary, unpaid care to at least one person with care needs.
Section 7: Applicant’s declaration and consent
- I confirm that I have read and understood the guidance notes and criteria for completing a Time for Carers application
- I confirm that the information on this application form is correct
- I consent to my personal details included on this application form being shared with Leeds City Council for their reporting purposes
- I understand that Leeds City Council may contact me about services for carers
- I consent to Carers Leeds processing and storing my personal information in electronic and manual format
By submitting this form - you indicate that you have read and agree to the above statement in 'Section 7 - Applicant’s declaration and consent'.
Section 8: Information, advice and support for carers
Carers Leeds offers a wide range of confidential information, advice and support for adult and parent carers in Leeds. If you would like to talk to one of the Carer Support Workers, please tick one of the boxes below or contact our Carers Advice Line by phone 0113 380 4300 or by email firstname.lastname@example.org
Carers Leeds also produces a free newsletter every two months
Section 9: Payment details
If your application is successful you can choose either to receive a cheque or we can pay the grant straight into your bank account. Please tell us how you would prefer to receive the grant:
If your application is successful a member of Carers Leeds staff will contact you for payment details.
Note: If you select 'Bank Transfer' a member of Carers Leeds Staff will contact you to arrange payment direct to your bank account. Bank details will only be obtained by Carers Leeds after your application has been approved at the Time for Carers Panel.
Section 10: Monitoring data (This section is optional)
We collect this information to make sure our services are reaching all carers. The information you give us in this section will not be linked to your name or address.