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Self-Funded Support Request Form

This form is for families who live outside Gloucestershire, or families who are self-funding their advocacy. If this is your situation then we request an initial agreement to fund 5 hours at a rate between £49 and £65 an hour, depending on the support needed plus a set-up fee of £25. This cost will be agreed with you in advance and is on the basis that any unspent money would be refunded. Depending on the complexity of the case there may be a need for additional funds, but that is agreed with you before any additional hours are worked.


The advice will be provided in accordance with the Service agreement and Terms and Conditions


ONLY fill in this form if you are happy to proceed in agreement with the service agreement and Terms and Conditions. 

Your Details

Do you receive means tested benefits? This helps us to understand if you might be eligible for legal aid.
Yes
No
Is your concern related to an EHCP? If so please provide a copy of the EHCP.
Yes
No

Please give us some details of your concerns. Please include as much detail as you can about why you need support and we will arrange for someone with the relevant skills to get in touch with you to find out more.

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

CONTACT

Get in Touch

If you are being worn down by the challenges in getting the support your child needs and deserves – we may be able to help.

To request support please fill in our dedicated support forms located under the Advice Service tab.

 

Email Us on:​

info@parentandcareralliance.org.uk 

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Send a message

Please send us a message here for any general enquiries. Please note that this form is not for requesting support, please go to the relevant form on this website.

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