Grant Application Form

SSIT assists people with spinal cord injury, enabling greater independence and quality of life.

Make sure you read the guidelines first. Make sure you have all information to hand before completing the form as it cannot be saved part way through.

After submitting your online application, please send an email to [email protected] stating your name, and the date you applied. This will enable us to check that your online application has arrived safely; if we have not received it, we will be able to sort this out with you.

Personal Information

  
  

If you have made a compensation claim, please see separate form for completion
Equipment request information


Please give details of the assessment carried out:
  
  
  
£
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.

Personal circumstances
  
  
  

Please indicate which benefits you receive:
  
  
  
  
  
     


     


Please sign the form below to confirm the following:
Upload documentation

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



IMPORTANT