How did you hear about SSIT?:*
Equipment request information
Details of the item you are requesting funding for:*
Have you applied for funding elsewhere?
SSIT expects the applicant to have investigated all other sources of funding and can only pay for equipment that cannot be obtained in any other way.
Please indicate contribution (if known) in box provided.
If you are applying for a wheelchair you must approach your local NHS wheelchair services first. If they cannot help with your application please attach their rejection letter. Your application cannot be considered without this. Can you make a contribution towards the cost of this equipment?
Physiotherapist or Occupational Therapist Details
If your application relates to a mechanical item (eg. wheelchairs, wheelchair accessories, e-motion wheels, exercise equipment, profiling beds etc), you will need the supporting signature from your Physiotherapist or Occupational Therapist to say that they have assessed you using the equipment and that in their opinion it is suitable and safe.
Consultant, GP, Occupational Therapist, Physiotherapist, Social Worker or Care Manager Details
If your application is not for a mechanical item, please ensure that your Consultant, GP, Occupational Therapist, Physiotherapist, Social Services or Care Manager supports your application.
If you have any relevant information that you feel might help support your application, such as a letter of support, quote from a supplier for item requested, a rejection letter from NHS Wheelchair Services, please upload them here