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Who is the advocacy for?
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Self
Other
First name
Last name
Date of birth
Gender
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Male
Female
Non-Binary
Transgender
I’d prefer to use my own term
Prefer not to say
I’d prefer to use my own term
Email
Telephone no
‘Note: this cannot be the same as the referrer’s phone number’
Placement
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Not care experienced
At home with adoptive parents
At home with parents
With friends/relatives
Foster carers purchased by LA
Foster carers provided by LA
Permanent placement with prospective adopters
In other community
In Local Authority home
In children’s home
In residential school
In secure accommodation
Crisis care
Other residential
Homeless
Supported accommodation
In own tenancy/independent living
Prison
Which local authority is the social work department from?
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Aberdeen
Aberdeenshire
Angus
Argyll and Bute
Clackmannanshire
Dumfries and Galloway
Dundee
East Ayrshire
East Dunbartonshire
East Lothian
East Renfrewshire
Edinburgh
Falkirk
Fife
Glasgow
Highland
Inverclyde
Midlothian
Moray
North Ayrshire
North Lanarkshire
Orkney
Perth and Kinross
Renfrewshire
Shetland
South Ayrshire
South Lanarkshire
Stirling
The Scottish Borders
West Dunbartonshire
West Lothian
Western Isles
Other
Ethnicity
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White
Mixed Race
Black Caribbean
Black African
Black Other
Asian Other
Chinese
Indian
Pakistani
I`d rather not say
Other
Ethnicity Other
Disability
Hold down the ctrl button to select multiple options
No
I`d rather not say
Visual impairment
Hearing impairment
Learning disability
Developmental or neurodiverse condition
Physical disability
Mental health condition
Long-term illness, disease, or condition
Other
Other
Postcode
Find address
Address line 1
Address line 2
Address line 3
Town
Postcode
Geographical Local Authority
Select...
Aberdeen
Aberdeenshire
Angus
Argyll and Bute
Clackmannanshire
Dumfries and Galloway
Dundee
East Ayrshire
East Dunbartonshire
East Lothian
East Renfrewshire
Edinburgh
Falkirk
Fife
Glasgow
Highland
Inverclyde
Midlothian
Moray
North Ayrshire
North Lanarkshire
Orkney
Perth and Kinross
Renfrewshire
Shetland
South Ayrshire
South Lanarkshire
Stirling
The Scottish Borders
West Dunbartonshire
West Lothian
Western Isles
Other
Is this referral related to a Child Protection Process?
Please select
Yes
No
If the young person received advocacy in the past, let us know who their advocacy worker was
Briefly, tell us why you think the young person needs advocacy
First name
Last name
Email
Telephone no
Postcode
Find address
Address line 1
Address line 2
Address line 3
Town
Postcode
What's your relationship to the young person
Please select
Third Sector organisation
Social Worker
Parent
Friend
Residential worker
Teacher
LAC nurse
Foster carer
Family member
Helpline
Scottish Govt. / DOLs
Bairns Hoose
Other
By ticking here, you are confirming that the person you are referring knows you are making the referral and that you are sharing their details with us
Is there an upcoming meeting/hearing for which advocacy is needed
Please select
Yes
No
Date of upcoming meeting/hearing
Is Young person address is a non-disclosure address
Please explain why you are sharing a non-disclosure address and advise whether it is safe for us to visit the child/young person there. If it is not appropriate to share the non-disclosure address, please put c/o referrer in the address box in Section 2
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