Application Form

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Application form & Equal Opportunities Form for Aphasia Re-Connect

We operate an open application system. This means that you can complete an application form if you are:

  • a person with aphasia
  • a relative
  • a friend
  • a healthcare professional
  • other

We ask you to complete both forms and then send them to us by:

  • email to:
    •, OR
  • post to: Aphasia Re-Connect, 17 Elm Road, Beckenham, Kent BR3 4JB

Download a copy of the Application and Equal Opportunities forms here: