AED Application Form

Things you should consider before applying for an AED

You will need to make a contribution of £900 towards the overall cost of the AED and cabinet.
The defibrillator must be freely accessible to the public 24/7 and be placed externally in the supplied unlocked cabinet.
The defibrillator must be located in either East or West Sussex.
You must investigate if there is already an AED located nearby.
Do you have or need permission for the AED to be installed at the proposed location?
The cabinet must be connected to a mains power supply.
The device must have a named ‘Guardian’.
Are there other organisations nearby that could also benefit?
How will you raise awareness of the device once installed?

Click here for AED Grant Frequently Asked Questions

Personal Details

Title *

First Name *

Last Name *

Email *

Phone *

Organisation Details

Are you applying as an Organisation or Community Group?

Yes

Name of Organisation or Community Group

Position in Organisation or Community Group

Address of Organisation or Community Group *

Country

City

State

Zip code

Brief description of Organisation or Community Group

Website

AED Location

Address of where AED is to be located *

Country

City

State

Zip code

Phone for this location *

Email for this location *

Where precisely will the AED be located? *

e.g. on the outside wall to the left of the main front door

AED Guardian (Responsible Individual)

(Must be an individual with day-to-day access)

Title *

First Name *

Last Name *

Email *

Job Title

Additional Information

Will the AED be available 24 hours a day? *

Are you seeking, or have you received funding from any other organisation? *

Please provide details

Why are you seeking an AED Grant? *

Please give as much information as possible. Include details such as the number of customers, visitors, the local population, surrounding businesses or any other local organisations which may benefit.

Where did you hear about us? *

Declaration

I declare that the information given on this form is true and accurate
I agree to abide by the conditions set out by the Sussex Heart Charity
I have read and understood the criteria and Frequently Asked Questions
I understand that if my application is approved, the named Guardian (Responsible Individual) will need to carry out regular checks on the device and organise the purchase of replacement electrode pads and batteries as required.

Check to confirm and submit your application *

I AGREE

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