Donmentia Grant for Short Breaks

Please note that previous applicants are welcome to apply for another grant but priority will be given to new applicants.

    Please answer all questions as failure to complete the form fully and accurately may result in your application being rejected or delayed.

    Full Name of the person with the diagnosis of dementia (pwd)


    Name of primary carer

    Address if different from pwd

    We cannot process the grant application without a contact email

    Name of person completing this form

    Contact details if different from above


    Relationship to pwd eg spouse, family, friend, carer

    Who made the dementia diagnosis eg doctor, psychiatric nurse?

    When was the diagnosis completed? Approximate date is sufficient.

    Please explain what your holiday/short break will involve e.g. hotel break, respite break, visiting a relative etc..

    Funding

    DonMentia may need to make the relevant checks to ensure that the person has a diagnosis of dementia. We may also request photos and a short testimonial for the DonMentia website. By ticking this box you approve us to do so.

    Please note that, whilst we would love to say 'yes' to every single application, we are having to restrict grants to a maximum of £500 per year per family.

    This form will be sent directly to admin@donmentia.org - you should shortly receive a confirmation email.