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Neurodevelopment Through Movement Form

The purpose of Neurodevelopment Through Movement Grants is to support the provision of specialised movement lessons for children

Neurodevelopment Through Movement Application Form

This field is for validation purposes and should be left unchanged.

Please note that this application form must be completed by an application referee. This should be a health care professional such as an Occupational Therapist, a GP or registered Neurodevelopment Through Movement practitioner working with the individual.

About the Applicant (beneficiary)

Name(Required)
Address(Required)
MM slash DD slash YYYY

About You (the application referee)

Name(Required)
Please state the healthcare organisation that you work for if relevant
Please provide an alternative number that you may be contacted on.
Organisation Address(Required)

What are you applying for?

Please briefly explain the nature of the disability and circumstances of your client
Please supply us with costings
Drop files here or
Max. file size: 128 MB.
    Please include supporting documents e.g. quotes/estimates/brochures. NOTE: Payment will be made direct to the supplier/organisation delivering the goods or services; in exceptional circumstances, payment can be made to the individual on receipt of relevant receipts.

    Consent

    This application requires a signed consent from the applicant. This can be downloaded from our website, completed, scanned and uploaded here or a hard copy may be posted to our offices. (Please see consent form for details.)
    Max. file size: 128 MB.

    Monitoring Information (Optional)

    Please tick all that apply to the applicant (beneficiary) below. Please note that this information is collected for monitoring purposes only, will have no impact on the outcome of your application and is answered entirely at your discretion. Thank you.
    Age
    Ethnicity

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