The first electronic form on this page is to be completed if you wish to refer yourself. Please complete the second form on this page (further down) if you are applying on behalf of someone else.

 

 

DSP Self Referral Form (for those applying on their own behalf)

Do you have a formal diagnosis of a Learning Disability and/or Autism? Required
Select the diagnosis you have Required
Required
Required
Required
Required
Required
Required
Required
What is the best time to contact you? (you can select more than one option) Required
Required

 

 

 

DSP Self Referral Form (applying on someone else's own behalf)

Do you have consent to complete this form on their behalf? Required
Does the person you are referring have a diagnosis of a Learning Disability and/or Autism? Required
Select the person's diagnosis Required
Required
Required
Required
Required
Required
Required
Required
Required
What is the best time to contact you? Required
Required