Intermediary Service Expression of Interest Form

Section 1: Your Contact Information

Your Phone number(Required)

Your email address

Your local authority(Required)

This is the local authority where you live. If you are unsure of your local authority you can check by entering your postcode on this website: www.gov.uk/find-local-council

Section 2: About You

Section 3: Accessing Intermediary Services

Intermediary Services include support in searching for, approaching and reconnecting with relatives separated by adoption where contact is wanted. Your answers in this section will help us to offer you the right service to best meet your needs and determine whether any services could be fully or part funded.

Some new Intermediary Services grants have been made available by Adoption England for those affected by adoptions that took place in 1976 or earlier. Because we don’t know how many people will express an interest in accessing these new grants we may need to prioritise this funding using the following criteria; age, life threatening condition, income and whether an intermediary service has been received before.

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Tell us more about your life threatening condition(Required)

If 'yes' how long ago was this and what was the result?

Thank you for completing this expression of interest form. We will contact you as soon as we are able to with details about the services available to you, what to expect, the support we offer and applicable costs.

We do appreciate that completing this form may have been triggering and difficult for you – please do contact our FamilyConnect Advice Line if you need to speak to someone about your situation.