Parent Support Request Form

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Please complete this form to request signposting/ information/ advice and other support from Family Voice Peterborough.

We can help with food support, training sessions, access to either family based activities or vouchers for activities, advice relating to Special Educational Needs or Disability issues or simply point you in the right direction.

We will use some information from this form to identify themes and help with funding requests and monitoring.

We also use the information on this form to direct you towards the relevant services/ organisations/ charities who can then work with you on an individual level (This is what is referred to as signposting)

Questions relating to your details and your child(ren)s details help us to contact you and provide more specific signposting.

Date *

YYYY

Name (First and Last) *

Please provide your email address (write N/A if you do not have an email address) *

Please provide your phone number *

Please provide your home address *

What is your ethnicity?

This question is optional, but will require a box to be checked to progress, so if you would prefer not to provide any information, please choose 'prefer not to say'. This information, helps to to ensure we are gathering a range of views, that reflect the diversity within Peterborough. This data is always anonymized, and only trends are reported on.

White, English, Welsh, Scottish, Northern Irish or British

Gypsy or Irish Traveller

Roma

Any other White Background

White and Black Caribbean

White and Black African

white and Asian

Any other mixed or Multiple ethnic background

Indian

Pakistani

Bangladeshi

Chinese

Any other Asian background

African

Caribbean

Any other Black, Black British of Caribbean background

Arab

Any other ethnic group

Rather Not Say

Other:

Clear selection

Child/Young person specifics (Please include age, gender, area of need, school placement) *

What support do you require *

Signposting

Food Support

Education/ Health or Social Care Advice

Short Break

Other:

How can we help? *

How did you hear about us? *

This may be word of mouth, leaflet via your cild's school, leaflet at GP surgery etc

How would you like us to contact you? *

Phone

Other:

Required

GDPR Statement *

By providing consent, you are agreeing that you understand that your responses will be collected, stored securely, and the data will be reported on and shared with relevant organisations for the purpose of improving SEND provision with Peterborough and for funding and grant monitoring purposes. Personally identifiable data will be gathered via this form. You have the right to ask for your data to be removed however this may impact on the service we can provide. Any personally identifiable data will not be passed to any third party without your clear written permission. This will only be possible for information that can be linked back to a single respondent. If you wish to find out more, and be kept informed/ involved you will be have to email participation@familyvoice.org *

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