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Make a referral to The Harley Jae Trust!

Please fill out the form below to refer a child or to request Extra Support from The Harley Jae Trust. We will review the referral and get back to you as soon as possible.

Start a referral with us!

At HJT we accept referrals for both individual children and multiple children as part of our Extra Support Fund. We will review the referral and get back to you as soon as possible.

Important information:

  • This form is designed to be filled in by Healthcare Professionals only.
  • Applications for grants can only be made for children who have been admitted in hospital for 6 weeks (42 days) or more.
  • You cannot apply for the same grant more than once in a 12 month period, but are able to apply for different grants. (Eg. You cannot apply for two 'Going Home Wishes' within 1 year, but you could apply for a 'Going Home Wish' and a 'Comfort Fund' in that 1 year period.)

If you require any information or assistance when completing this form, please Contact us.

Referrer's Details

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Donate to The Harley Jae Trust today!

Text harleyjae3 to 70085 donate £3 per month or visit our donation page to give a one off donation!

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