Support request from Professional

REQUEST SUPPORT

Please complete this form, in as much detail as possible, to share your concerns and one of our Advisers will be in touch as soon as possible.

Support that we may be able to provide might include individual support for families, help preparing for and attending meetings with any agency supporting their child/young person (assessments, reviews, planning meetings, child protection conferences, EHCP reviews, health care planning meetings etc); supporting them to make effective complaints; facilitating meetings between them and professionals to ensure effective communication; helping them through complex procedures, writing letters, putting across their views etc

Parent and Carer Alliance C.I.C. are recipients of funding from the National Lottery Community Fund which can reduce the costs of services that we are able provide to families who live in Gloucestershire, and whose children/young people have additional needs, so please answer our questions as this helps us to know eligibility for this funding, or if we can offer other advice or support.

UNFORTUNATELY FUNDING IS NOT AVAILABLE IF THE FAMILY DO NOT LIVE IN GLOUCESTERSHIRE

Once you have submitted this form we will be in touch , with either you and/or the family to explain how we might help as soon as possible.

The initial consultation (by phone or email) will be free and during this discussion, any decisions about ongoing support and any costs that might be involved, will be made in agreement with the family. If you are self-funding advice is charged at £47.50 per hour, with an initial admin set-up charge of £25.

By completing this form you are not committing the family in any way, you are just helping us to understand how best to help.

Your First Name Please tell us who is making this referral

Your Surname

Your role and organisation Please explain your relationship with the family, and give details of the organisation that you work for

Your Phone number Please tell us a number that we can contact you on

Your email Please tell us an email address to contact you on

Permission to share Family's information

Please ensure that you have the consent of the family to share this information with the Parent and Carer Alliance C.I.C. before proceeding any further

Permission to share Family's information Please select one answer

Yes I do have the Family's permission to share this information

Is your concern urgent? If there is a date soon that you need support for, such as a meeting or case conference please tell us here

Postcode Please tell us where the family live, as we may have funding to provide reduced cost services

Please give some details of your concerns

Please tell us about why you would like/ the family needs advice and support and we will arrange for someone with the relevant skills to get in touch with you and find out more.

It would be useful to know what additional needs the child/young person has, what service(s) (e.g. education, social care etc.) are of concern and the type of issues that there are - failure to discuss/assess needs, failure to provide agreed needs, etc.

Child/Young person's additional needs Please highlight all that apply, hold down the control key and click to select.

Child/Young person's Other Additional needs If you selected Other please give a brief description of these needs

Describe the issues Please summarise your concerns so we can select the best adviser to help

Which agencies are involved? Knowing who is involved in causing you concern can help us advise you

How do these concerns affect the family? Please summarise their experiences

What support do you hope we can provide Please tell us how we could help

EHCP details

If you are asking for support with an EHCP - draft, review or in preparation for Tribunal, please click here to send a copy of the EHCP for an Advocate to review.

Have you emailed us an EHCP?

Yes I have emailed an EHCP

Have the family had support from the Alliance before? Please click on the arrow and select your answer

Yes the family have had support before

No the family have not had support before

I don't know

Agreeing to Give Feedback

The Parent and Carer Alliance C.I.C. is only able to get funding to provide advice and support through Grant funders, such as the National Lottery Community Fund.
For funding to continue to be given, the Alliance needs to demonstrate how the support we provide helps.
We need YOUR HELP and FEEDBACK to do this, as telling us what worked for you, helps funders understand why these services are needed

Do you agree to provide Feedback on support? Please select your answer

Yes I agree to give feedback

Who should we contact to discuss what support could be provided? Please click on the arrow and select your answer

Family member's First Name Please tell us who to contact in the family

Surname

Phone Number Please give the number the family member can be contacted on

Email address Please tell us a contact email for the family

CONSENT TO SHARE NOTICE

I have read and understood the Parent and Carer Alliance C.I.C. Privacy Policy, click here to read the Privacy Policy
By proceeding, I confirm that the family have given permission to me to share this personal data with the Parent and Carer Alliance C.I.C. and to being collected and used as stated in the Privacy Policy, and in this Notice:

The Parent and Carer Alliance wish to collect and use the following types of personal information for the following reasons:

To enable you to sign up for services, advocacy, training, information events, social activities and outings;
To provide you with support and guidance that is tailored to your needs;
To provide relevant future events/training and services by understanding your personal situation and experiences;
To help us to demonstrate need both locally and nationally to help the Parent and Carer Alliance work effectively with other organisations to improve the services provided;
To access funding sources to develop what we can offer to our members and to offer reduced price support;
To request feedback from you about what you think about any service or support provided to you by the Parent and Carer Alliance e.g. feedback to the National Lottery of the impact of advice and support that you have received as a direct result of their providing funding, which may involve them contacting you; and
To track information about the use of our website including information obtained via cookies to develop the website.

The family can withdraw their consent to share their information at any time without detriment by email to info@parentandcareralliance.org.uk

Consent to share information

YES I have got consent to share this to access advice and support

Submit

Please click the submit button below to send this form and we'll be in touch very soon. Once the button is clicked a please wait message should appear, then disappear and be replaced by a thank you message at the TOP of the form.

If this doesn't happen, please scroll up for any error messages, as questions with a red star need to be answered for the form to submit. Any issues click here to contact us