"*" indicates required fields Step 1 of 4 25% Organisation name* Address* Street Address Address Line 2 City County / State / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Status*Registered CharityRegulated BodyOther (please specify)Other Registration no. Date your organisation/service was formed* DD slash MM slash YYYY Website* Facebook Instagram X (Previously Twitter) TikTok Primary contact* First Last Email address* Secondary contact* First Last Email address* Phone number* Section 2 – Your mission, objectives and activitiesDescribe your organisation’s mission and objectives.*(Max 1,000 characters)Tell us about the people you support.*How old are they, what clinical and care needs do they have, what are their challenges (Max 1,000 characters)What is your track record of delivering services for children and young people with life-limiting conditions?*Tell us what services you provide, where you provide them and what impact they have had. (Max 1,000 characters)How many children with life-limiting conditions do you support on average per year?* Section 3 – Application for Lifelites supportWhat is the name of your project?* Tell us about your project.*Tell us what you want to do, what activities will feature, where will the project take place, how will you make it happen. (Max 2,000 characters)How do you know this is needed?*Please tell us about the people who will benefit, what are their challenges, what evidence do you have the project is needed. (Max 1,000 characters)How many children with life-limiting conditions and complex needs do you expect to benefit?*Tell us about your project plan.*Tell us about when you expect the project to start, how long it will run for, where are you in the planning journey. Give us key dates and milestones. (Max 1,000 characters)Tell us about the project team.*Who will be leading the project, who else is involved, including 3rd party suppliers as relevant (Max 1,000 characters)What are the expected outcomes?*Tell us about the difference this will make to children, their families and your service. (Max 1,500 characters)Provide evidence that you have met or plan to acquire any statutory requirements to run this project.Max. file size: 32 MB.Planning permissions, regulated services etc.Project budget*Estimates acceptable at this stage. Section 4 - Additional InformationPlease provide any further information you feel is relevant to this applicationPlease upload a copy of your children’s safeguarding policy (and vulnerable adults if applicable).*Max. file size: 32 MB.Please upload a copy of your most recent accounts.*Max. file size: 32 MB.Please provide most recent CQC/Ofsted report (if relevant).Max. file size: 32 MB.Please provide any planning consent obtained (if relevant).Max. file size: 32 MB.Please provide any plans or project plans (if relevant).Max. file size: 32 MB.PhoneThis field is for validation purposes and should be left unchanged.