Butterfly Fund Referral Form

Referrals are currently being accepted ONLY for families living in:

• Scotland
• the Greater Manchester Combined Authority
• West Midlands
• Bedford, Luton & Milton Keynes
• Gloucestershire
• Bristol and the South West
• South East London (SE postcodes)

This form (below) should be completed by a professional who has been involved in delivering palliative care to a family before/at/after a child’s death.

In order for us to be confident that the family meet the Butterfly Fund’s criteria, please include details of how, and for how long you have known the family, under “How are you known to the family”

Families are only able to receive one grant so please check that another service or agency has not previously referred them.

Please take extra care when completing the family email address as this is where the voucher will be paid.

Unfortunately, we do not have capacity to respond to each referral and will only contact you should further information be required.

If approved, we will process the voucher for the family to be put in their online bank account or cashed at PayPoint within 4 weeks.