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The Family Support Collective

Section 1 of 7

Before you start

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Get help with this form

If you need help completing this form, please contact The Family Support Collective.

hello@familysc.co.uk

Who is completing this form?
Anyone completing this form under the age of 16 must be accompanied/have permission by a parent or guardian.
Which area do you live in?
How old are you?
Do you have children under 18 living with you?
How many children live with you and how old are they?
Number in each group.
Is there anyone in your home expecting a baby?
Does anyone in your household have a disability?
Do any of these apply to you?
Tick all that apply.
Is paying for any of these hard at the moment?
Is paying for any of these hard at the moment?
Tick all that apply.
Do you have enough food and heating for the next few days?
Would you like us to check if there is anything else you could claim?
Have any recent changes in your family affected your money?
For example, a new baby, a relationship change.
Is anything about your bills or debts worrying you at the moment?
Are you using credit, borrowing or an overdraft to get through day to day?
Is anything about housing, work or a legal issue worrying or confusing you at the moment?
Would you like help with work, training or childcare?
Are you a carer?
This means you give unpaid help to a family member or friend who couldn't manage without you, because of an illness, disability, mental health problem or addiction. It can include your own child.
Do you have a child in your care who is not your own?
For example, a grandchild or other relative.
Is anything at home feeling overwhelming just now?
Is it feeling a bit lonely for you at the moment?
Do any of these make family life harder?
Tick all that apply.
Would you like a bit of support from someone who can visit and listen?
Would you like to meet other parents, join a group, or feel more part of your community
Is anything about any of your children worrying you just now?
For example, sleep, feeding, behaviour, or how they are growing and learning.
Is there anything about the way your children think, learn, communicate or experience the world that would be helpful for us to know so we can support them in the best way possible?
Are any of your children missing school, or finding school very hard?
Is anyone at home feeling low, worried or stressed, and might want someone to talk to?
Lots of families go through times like this. Knowing helps us find the right support for you and the people you live with. You can skip this question if you'd rather not answer.
Who is feeling this way
Tick all that apply.
Would you like support with your own health and wellbeing?
Do you feel safe at home?
If you don't feel safe

If you are in danger now, call 999. You don't have to deal with this on your own. There are people who can help, and you can talk to them in confidence.

Find out how to get help

What is the one thing you most need help with right now?
Are you already getting help from any service?
How can we reach you?
Give us a phone number or an email address, or both.
What is the best way to contact you?
Tick all that apply.
Is it safe for us to phone, text or leave a message for you?
Are you happy for us to share your answers with the local services that can help you?
Privacy
Read our privacy notice to see what we keep, who can see it and for how long.