PaCC reps recruitmentComplete the expression of interest form. Do email [email protected] if you need any help with filling the form in.email usexpression of interest formPaCC Steering Group Your Name * First Your Name Last Last Email * Phone * Tell us about your role as a parent carer e.g. your child’s age, SEND, what services they have accessed and type of school (only share what you feel comfortable to). This will help us know where your experience fits with the current Steering Group. We are particularly keen to hear about any areas relevant to the gaps set out above. Area of interest e.g. autism pathway, EHCP processes, complex health needs. Tell us a bit about yourself and why you are interested in joining the Steering Group You can say what you feel you would bring in terms of your skills and experience, and what you hope to get out of it. Tell us about any support you think you might need in the role We are committed to fully supporting everyone who joins PaCC, but it’s helpful if you can give us any details at this stage of your support needs. Please share info on your availability e.g. school hours only / I work PT Tues-ThursDiversity informationPlease note that under the Disability Discrimination Act 1995 you are considered disabled if you: - have a physical or mental impairment - this impairment has an adverse effect which is substantial - the effect is long term (usually lasting more than 12 months) - there is an adverse effect on your ability to carry out day to day activitiesReligion and Sexuality: these questions are from guidance based on the Equality Act 2010.You can choose to leave any section blank if you wish.Age 16-24 25-35 36-45 46-55 56-65 65+Gender Woman Man Non-binary Prefer not to say I prefer to use my own termI prefer to use my own termEthnicity Indian Pakistani Bangladeshi Chinese Caribbean African White and Black Caribbean White and Black African White and Asian White British White Irish Traveller of Irish Heritage Gypsy/Roma Any other Asian backgroundAny other Asian background Any other Black backgroundAny other Black background Any other Mixed BackgroundAny other Mixed Background Any other White BackgroundAny other White Background Any otherAny other What is the main language you use at home? Do you consider yourself to have a disability? Yes NoSexuality Gay woman/Lesbian Heterosexual Gay man Bisexual Prefer not to say I prefer to use my own termI prefer to use my own termReligious belief Atheism Buddhism Christianity Hinduism Jainism Judaism Islam Sikhism OtherDo you have caring responsibilities? (select all that apply) None Primary carer of a child/ren (under 18) Primary carer of disabled child/ren Primary carer of older person Secondary carer (another person carries out the main caring role) Prefer not to sayreCAPTCHA If you are human, leave this field blank. submit
