Please ensure that you have consent for the person/family you are requesting support on behalf of. Please note that submitting this form is considered only as an enquiry, we use this information to undertake a triage processes to establish whether we are able to accept a referral and provide services. We kindly ask that you complete this form as fully as possible in order for us to effectively triage your enquiry as quickly as possible. Cambridge Acorn Project is grant funded and so we ask you to please share any known funding possibilities to support for the child or young person, for example, Pupil Premium (and Pupil Premium Plus), and school funding including EHCPs, local authority funding, or any other known funding possibilities.

Name of professional making enquiry *

First Name

Last Name

Organisation and role

Email *

Phone *

(###)

###

####

Key Info

Name of Child

First Name

Last Name

Date of birth

YYYY

Gender and pronouns

Name of Parent/Carer

First Name

Last Name

Phone

(###)

###

####

Family address

Child's ethnicity

Main language spoken

Child's school contact

Other professionals involved and contact details

Does the child have an EHCP?

Yes

If yes, please describe the child's needs

Is the child entitled to pupil premium

Yes

Is the child entitled to free school meals?

Yes

Are the family facing financial hardship?

Yes

Is the child/family accessing

Universal services

Early Help/Targeted Services

S17 Child in Need

Child Protection Plan

Is the child a LAC/previous LAC?

LAC

SGO

Adopted

Any other relevant information?

Support Needs

Please describe the support needs and issues involved including as much detail as possible

Please tell us about the child's strengths and any activities the child is enjoying/wants to do

Please include details of any current professional involvement

Please detail any previous professional involvement

Funding Avenues

We will need to fund this work from somewhere. CAP is a charity, and we are prepared to help with doing this but we need to explore possible avenues as we don’t have our own funding. These questions are important for us in exploring potential funding avenues which we can later discuss with the family.

Has the child been exposed to domestic abuse? If so, how recently?

Please detail current jobs/work commitments parent(s)/carer(s) has had – particularly part-time, or full-time

Have the family had a significant crisis in the last 12 months? Please tell us more about this if so

Do the family have any disability, special educational, or medical needs?

Do you have access to any funding which could support the work? E.g. pupil premium, social care funding or EHCP?

Consent

Before submitting this form, please ensure that you have read and agree to Cambridge Acorn Project’s Terms of Service (available at the bottom of this page) *

By ticking yes and submitting this enquiry your are confirming that you have obtained consent from the parent(s)/carer(s) for this enquiry and that: • This form contains accurate information. • Parent(s)/Carer(s) have given consent to Cambridge Acorn Project to deliver services in response to your enquiry. • Parent(s)/Carer(s) agree to Cambridge Acorn Project’s Terms of Service

Yes,

Please type your name *

Thank you for getting in touch with us. We will carefully review your form and a member of staff will get in contact with you to follow up as soon as possible. If you have any questions or want to send additional information in support of this enquiry, please contact us at info@cambridgeacornproject.org.uk

Click here for Cambridge Acorn Project’s Terms of Service

Cambridge Acorn Project

Future Business Centre, King’s Hedges Road, Cambridge CB4 2HY

Registered Charity No: 1175019 Company No: 9187469

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