Please complete the form below. All the information you provide is treated confidentially.

Section 1: About you and your circumstances

We’ll contact you by email about the status of your grant application, unless we know this won’t work for you.


Please tell us the reason for your application, for example:
• Why you are in difficulty and how long you have been experiencing problems relevant to what you’re asking for help with?
• If you/your partner are off work through illness or other reasons please give details and anticipated return to work date if known
• The impact that these unforeseen circumstances have had on your finances
• Any other information that will help us to understand your situation


What type of support are you hoping to get from RCN Foundation Benevolent Service?
Please state how you would like us to help you including:
• The difference our help could make and how you will be able to manage going forward
Note: we may not always be able to help with everything and financial support could be in the form of a contribution rather than the full amount. There are also certain things that we are not able to help with.


Section 2: Your household

We ask this so we can understand what additional support and benefits to direct you towards. RCN Foundation grants can be awarded to applicants who have no recourse to public funds.


Section 3: Your income (earnings)


Section 4: Your income (savings, capital and other)

An example of capital could be a property you don't live in.

Other income sources could include maintenance for children, or an occupational pension

Section 5: Your income (benefits)

Please enter the monthly amount of any benefits you receive

Section 6: Your partner's income (earnings)

If you do not have a partner living with you, or your partner does not work, then you do not need to complete this section.

Section 7: Your partner's income (benefits)

Please enter the monthly amount of any benefits your partner is receiving

Section 8: Your partner's income (savings, capital and other)

An example of capital could be a property they don't live in.

(e.g. occupational pension, or maintenance)

Section 9: Expenditure

Please enter your monthly expenditure on the following items

(Please tell us your monthly rent charge and how often you pay it. Don’t include any additional amount you might pay for arrears.)

(Please tell us your monthly mortgage charge and how often you pay it)

(Ignore any benefit you may receive towards this)

(Do not include payments towards arrears.)

(Do not include payments towards arrears.)

(Please tell us roughly how much your household’s essential food and toiletries would cost for a one month period.)

(Please tell us roughly how much your household needs to spend on essential clothing and shoes per month.)

(e.g. nursery, registered child minders or childcare provided through school.)

(for children not living with you)

(due to ill health or disability)

(Please tell us roughly how much your household needs to spend on petrol this month.)

Please list any debts you may have and how much you pay towards them each month. This may include car finance, rent arrears, credit cards, personal loans, store cards, arrears for council tax and utilities.

We appreciate these won't be your only costs. Please have figures for costs not included above to hand at the time of your appointment. You don't need to add them in to the above sections.

Supporting the RCN Foundation


Equal opportunities

Completion of this section is helpful to ensure that we are aware of the communities applying for this scheme and assists in the implementation of equal opportunities. This information will not form any part of the selection process and will be treated with total confidentiality. You don’t have to complete this part of the form.

Disability is a physical or mental impairment, which has a substantial and long-term adverse effect on a person’s ability to carry out normal day-to-day activities.

The information you’ve written on this form will be used to assess your application for a grant. If you appear to meet criteria for a grant you’ll also be asked to send us documentation such as bank statements.

The Royal College of Nursing (RCN) and RCN Foundation need to keep your data on paper or computer to assess your application.

If applicable, we will also request bank statements and other supporting documents from your partner or spouse to show that your household income and savings are within our grant assessment criteria. This will include a separate form for your partner to sign to check they understand our data protection policy and consent to us viewing their supporting documents and holding their data.

We may also use the information for accounting, audit, statistical or research purposes. We will not disclose any of your information outside of the RCN and RCN Foundation, unless we are legally obliged to do so or unless you have given us your prior consent.

We will undertake to keep your information strictly confidential and do everything we can to prevent the information being used in any unauthorised or unlawful way. Our current policy is to retain personal data for a period of 7 years from when a decision on your application is made, after which it will be destroyed. You have the right to request information about the details we hold about you and we will provide this data as legally required. All requests regarding the RCN’s data protection and privacy policy should be sent to: Data Protection Officer, RCN, Copse Walk, Cardiff Gate Business Park, Cardiff, CF23 8XG or email dataprotection@rcn.org.uk.