If you need any help with this form, you can call us on 0300 222 5742.
You need to get the person's consent before you apply for this service on their behalf.
They need to be at least 16 years old to use this service.
There is advice for disabled people looking for work and advice for disabled people in work on our website.
You can also call our helpline for advice on 0808 800 3333.
Apply for Support to Work Extra
Support to Work Extra is a service for disabled people.