This short data collection form is anonymous and helps the Forum secure funding.Thank you for joining the Parent Carer Forum, our role is to bring together the voice of Parents Carers to help improve local services for disabled children and their families. If you can spare a few minutes to complete this anonymous form it will help ensure our funding continues, enabling us to make more impact for local families. The questions below will help us understand more about our members and help us show which areas and communities we are reaching and those where we need to do more work to engage with parent carers. Thank you so much for your time.Please enable JavaScript in your browser to complete this form.Postcode *This helps us show which districts our members reside in and may support our bids for funding to support targeted areas of the county.Your age now *Prefer not to sayUnder 1818-2526-3536-4546-5556-6566-75Over 75Do you you have any impairments or conditions and consider yourself to be a disabled person?Nationality *What is your nationality Ethnic Background - choose the option that best describes youPrefer not to sayWhite English/Welsh/Scottish/Northern IrishWhite IrishGypsy or Irish TravellerAny other White backgroundWhite and Black AfricanWhite and Black CaribbeanWhite and AsianAny other Mixed / Multiple ethnic backgroundIndianPakistaniBangladeshiChineseAny other Asian backgroundBlack AfricanBlack CaribbeanAny other Black/African/CaribbeanArabAny other ethnic groupIt is important for us to understand if we are reaching communities who are often not well represented.Ethnic background not otherwise specifiedIf the ethnic group categories do not adequately describe your background, please specify here. Additional Background Information - please tick any you identify as being part ofSpeak English as an additional languageTraveller communitiesLesbian, Gay, Bi-sexual, Transgender, Queer, Intersex,, Asexual or any other gender or sexual orientationFamilies with unsettled ways of life (e.g. former asylum/recent refugee status).Very low - income families or families who's income drops suddenly due to a change in circumstances, self employed.Young or new parent carers (you are under 18)New to caring role e.g. grandparent/kinship carers/foster carersRural or geographically isolated familiesFamilies with health conditions where disclosing could have a wide ranging impactingIt is important for us to understand if we are reaching communities who are often not well represented. We may be able to apply for funding to further support families from any or all of these communities.How many children with additional needs do you have? *Gender of child/childrenFemaleMaleOtherPrefer not to sayWhat are your child’s/children's conditions/impairments/additional needs? *ADDADHDAnxietyAttachment DisorderAutism Spectrum ConditionCerebral PalsyChromosomal ConditionCommunication ImpairmentDepressionDeafnessDown SyndromeDyslexiaDyspraxiaEpilepsyHearing ImpairmentLearning Impairment (mild-severe)Mental Health ConditionPathological Demand Avoidance (PDA)Physical ImpairmentProcessing DifficultiesProfound/Multiple Learning DifficultiesSensory Processing DisorderSpeech and Language ImpairmentVisual ImpairmentOTHERPlease highlight all that apply. If any condition is not listed please add it in the next reply.Does your child/children have any other physical or mental health condition?Please tell us what the other physical or mental health condition(s) areWhat type of education setting do your child(ren) attend? *Home EducationHospital EducationNone at this timeEarly Years SettingMainstream Primary/Infant/JuniorMainstream Secondary Comprehensive/GrammarPrivate SchoolResidential SchoolSpecialist SchoolApprenticeshipFE CollegeSixth FormUniversitySupported InternshipPlease highlight all which applyWhat level of SEND support does your child(ren) have? *My ProfileMy PlanMy Plan +EHCPNonePlease highlight all that apply.Do you receive Care Support, if so at what level? *NoneDLA Care (Lower)DLA Care (Middle)DLA Care (Higher)DLA Mobility (Lower)DLA Mobility (Higher)PIP Daily Living (Standard)PIP Daily Living (Enhanced)PIP Mobility (Standard)PIP Mobility (Enhanced)Please highlight all that apply.What services do you currently access or have accessed in the past? *Please help us to understand the needs of your family.What issues do you currently face regarding services? *Please help us to understand the needs of your family.MessageSubmit