Needs Assessment
The following information is required in order to assess your needs and to also supply data to our potential funding bodies. This will only ever be shared anonymously and the information opens up funding opportunities for the charity to support families living with issues surrounding Parental Alienation. The charity cannot provide legal advice on individual cases. We can signpost to relevant organisations, provide guidance and support and offer general advice where possible.
Name
First Name
Last Name
Email
example@example.com
Phone Number
-
Area Code
Phone Number
What region do you live in?
Please Select
Cymru Wales
East Midlands
East of England
London
North East & Cumbria
North West
Northern Ireland
Scotland
South East
South West
West Midlands
Yorkshire & the Humber
Date of birth
-
Month
-
Day
Year
Date
Gender
Female
Male
Prefer not to say
Ethnicity
Please Select
White British
Irish
Welsh
Scottish
Other white background
Asian or Asian British
Bangladeshi
Indian
Pakistani
Other Asian background
Black or Black British
African
Caribbean
Other Black background
Chinese
Other ethnic group
Mixed race
White and Asian
White and Black African
White and Caribbean
Other Mixed background
Prefer not to say
Sexuality
Heterosexual
Bisexual
Lesbian
Gay
Prefer not to say
In what capacity are you affected by Parental Alienation?
I am an affected parent
Child
Stepparent / partner
Grandparent
Friend
Other family member
Professional working with the client
Is the case currently, or has it previously been in the family court?
Yes
No
I don't know
If you answered 'yes' to the previous question do you know how long the case lasted?
Please Select
Currently ongoing
6-12 months
1-2 years
2-3 years
3-4 years
4-5 years
5+years
Did you attend mediation prior to family court proceedings?
Yes
No
I don't know
If you answered 'no' to the above question what were the reasons for not attending
Ex-partner declined
Domestic abuse allegations
Financial difficulties
Other
What sort of support are you looking for?
Legal help
Emotional support
Mediation
Other
Please use this box to add any other supporting information you feel is relevant to help us understand the current situation.
Submit
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