Please answer the questions below with as much information as you can, so that we can see if you might be eligible for the Family Fund Mobility Support.

We do not need to know the details of your child’s condition or diagnosis, but we do need to know what extra needs your child has around getting around and mobility relating to their disability, condition or illness.

Before you complete this form, please tick to confirm you have read the terms and conditions:
Family Fund Number
Main Carer's
Main Carer's Surn


Please tick if you or your partner holds a full UK a driving licence:
Please tick if a member of your household receives the mobility element of Disability Living Allowance:
Child's First Name:
Child's Surname:
Child's Date of Birth (DD/MM/YYYY):
 How many other children are there in your household, including ages of the children:


Please tick if there is another person regularly involved in supporting the additional care needs of your child and they hold a driving licence:
Contact's First Name:
Contact's Surname:
Their relationship to the child:
Child's condition and needs (to highlight more than one option, click and hold CTRL):

What difficulties do you have with transport or getting around in relation to the additional support needs of your child?
What difference would having a vehicle make to you and your child?

When you submit this form you will be redirected to this page. You should receive an email to the address provided above as confirmation we have received your application.