Chance UK STEP mentoring referral form

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This programme is to support year 6 children with past/present CAMHS involvement or ACEs with the transition into year 7 via 1:1 mentoring and family support. Please note we have reached capacity for referrals of children with Autism Spectrum Condition (ASC) and cannot accept any more this intake.


Full details about the programme available
here.


Referrals: OPEN for current year 6s. 


Chance UK logo
February 2021: Referrals are open until all funded places are full
Spring 2021: Chance UK staff assess referrals and virtually 'meet' families over the coming months
May-July 2021: Families are introduced to their mentor. 1:1 mentoring begins (either in person or via video/phone depending on current guidelines) and continues for 9 months through the summer holidays and into year 7 



CHILD







If the child is not in year 6, please don't refer them as we won't be able to accept them on this programme





MAIN CARER 









OTHER FAMILY MEMBERS








FAMILY - Further details 







RERERRER'S INFORMATION






School details



 

OTHER PROFESSIONALS INVOLVED WITH CHILD OR FAMILY









FURTHER INFO AROUND REFERRAL




 


Yes No Don't Know






MONITORING INFORMATION
The following themes are challenges faced by some of the families referred to Chance UK. These themes are monitored by Chance UK and do not determine whether a child is eligible for the mentoring programme. 





Thank you for completing the referral!

Based on feedback about our referral form, we have made the decision to remove the Strengths and Difficulties Questionnaires, so that it is easier for practitioners to complete.

For monitoring purposes, we will need to take an SDQ from both the main carer and a teacher, but will be in touch to do this once the referral has been accepted.

We hope this change helps practitioners to make the referrals they would like to.
PRIVACY NOTICES