1.Organisation Name

2.What geographical area does the organisation cover?

3.Please give a short description of the organisation's aims and what it does. If you are happy for us to take this information from your website please share the relevant web page.

4.What services do you currently offer, that would be useful and accessible to adults who identify as neurodivergent, autistic or with a learning disability?

5.Where in Northumberland can you meet people who may be referred?

6.Please give the contact details of the best person to talk to discuss making a referral

Name

Address

Address 2

City/Town

ZIP/Postal Code

Email Address

Phone Number

7.What is the process for referring someone to your services?

8.What could someone expect will happen next, once they have been referred?

9.If possible, please share any positive recommendations you may have had from satisfied users of your services

10.Are you happy to share your logo and some images to display? If so please email them to splintergroupnorth@gmail.com

Yes

No