To apply for one of our grants you can either apply by post or via the online form below. Before we can process your application we will also need to have received a copy of your registration documents or proof that you are registrable. Your application form will not move forward for review until we have seen these. Acceptable documents include:

  • Certificate of a person’s registration as Sight Impaired/Partially Sighted or Severely Sight Impaired/Blind (CVI)
  • BD8
  • Certification from the County Council (which is normally a small card).
  • Letter from an ophthalmologist stating that the young person’s sight is at a level which makes them eligible to be registered if desired (we will accept this if a young person is not yet registered).

If supplying a CVI please include parts 1 and 2. If you are sending a copy of a card, please make sure you include both sides. The information must include the applicants name, date of birth and visual acuity.

Applications can be made through our online form or by downloading the Word version and sending it by post.

To Apply By Post

app_downloadClick here to download
and print an application form.

Please return your completed form and supporting documents to:
VICTA Children
5 Douglas House,
32-34 Simpson Road,
Fenny Stratford,
Milton Keynes,

or by email to

To Apply Online

Please complete the following form. Supporting documents can be posted to the above address or emailed to

VICTA Grant Application Form

Fields marked with a * are mandatory.


Note for applicants completing this form

After completion, if you have successfully submitted the form, you should receive a successful submission message. If you do not it may be because you have not completed a required field. Fields which have not been completed will then be marked with the message 'This is a required field' so you may wish to search this.

After your form has successfully gone through you will also receive notification via email. If you do not receive an email please contact the office on 01908 240 831 as there may have been a problem with your application.

Part 1 – About the applicant

1a. Applicant Details

Applicants must be registered blind or partially sighted, or able to provide proof that they are registrable to qualify for a VICTA grant.

1b. Current education/employment details

In this section, please complete the details of your/the applicant's current school/college/university/employer as applicable to you/the applicant. If you/the applicant are not currently in education or employment, please provide details for your most recent employer or educational provider with the date of leaving in the indicated box.

Part 2 - Supporter Details

If you have a supporter e.g. a social worker or Qualified Teacher Visual Impairment (QTVI), please include their details here to support your application.

Please note, if you have any documents you would like to send to support the applicant's request further, they can be emailed to

Part 3 - Grant Information

Part 4 - Finance

Please Note:
If your application is successful, you will then be asked to make a financial contribution, at the trustees discretion, towards the purchase of your equipment.

Part 5 - Correspondence

Part 6 - Grant Form Completed By

Part 7 - Declaration

This section must be agreed to by the applicant if they are 18 years or over, or by the parent/guardian if the applicant is under 18 years of age.

  • I declare that the information provided on this form is complete and correct and I undertake to update VICTA should any of the information in this form change.
  • I understand that information given will be held under the terms of the Data Protection Act.
  • I agree that VICTA can use the information I have supplied on this form, including details about my sight condition, in order to deal with my grant application and provide me with information of other support services. I agree that VICTA may discuss the information given on this form with other organisations who may be asked to provide relevant information, goods and services to assist with this grant.
  • I agree to provide copies of the required supporting documents to VICTA. This will include copies of registration documents or proof that the applicant is registrable. Documents can be sent by email to or by post to VICTA Children Ltd, 5 Douglas House, 32-34 Simpson Road, Fenny Stratford, Milton Keynes MK1 1BA.
  • I understand that this form is a request for a grant to be considered by the Trustees of VICTA and that the Trustees decision is final.
  • I understand that if funding is approved VICTA is not required to provide payment towards the upkeep of this equipment, including replacement, maintenance, insurance, extended warranties etc. Any such undertaking shall be the responsibility of the beneficiary, parent, legal guardian or other.
  • I agree that if funding is approved and at a later date the recipient no longer requires this equipment, I/the recipient will endeavour to inform VICTA so they can decide if the equipment should be passed on to another young person who may benefit from it.
  • I consent to have any photographs/thank you letters that I send to the charity used for publicity purposes, including online and in printed documents.