School Staff/Parents Training Questionnaire for Screening

CBF Volunteer Application Form

Thank you for your interest in volunteering for the Challenging Behaviour Foundation (CBF). Please complete this form to apply for the roles of Local Champion and/or Family Link Volunteer. If you do not have role descriptions for these posts please contact us.

We would like to know a few details about you and your experience of challenging behaviour to ensure that you will be suitable for one of our volunteering roles.

If you would prefer this form in a different format we are happy to help. We can also complete this with you over the phone – just call us on 01634 838739.

About you

Your name
Telephone
Email
Address

We are currently accepting applicants from England only, as our project funding

from Big Lottery is specifically for England.

Which volunteer role are you interested in?

Local champion

Family Link Volunteer

Both

Not sure

Why would you like to volunteer for the CBF?

Can you give an example of how you’ve offered someone support or information?

About your family member

It is important that our volunteers have personal experience of caring for someone with severe learning disabilities. Please tell us about your family member below.

Please click in the boxes below to select.

How are you related to a person with learning disabilities? / I am a… / Parent
Grandparent
Sibling
Aunt/Uncle
Other
Please specify:
Name of family member
Date of birth
Sex / Male Female
How would you describe their level of learning disability? / Mild
Moderate
Severe
Additional diagnosis (e.g. Autism)
How would you describe their level of communication? / Non-verbal
Single words or signs
Phrase speech Full sentences

The CBF’s volunteers should have some experience of challenging behaviour. Please tell us below about behaviours your family member has displayed.

If you are unsure about any of these behaviours, please contact the Volunteering Coordinator to discuss.

Type of challenging behaviour / Does your family member display this behaviour now or has done in the past?
Yes/No (please describe if yes)
Self-Injury
(e.g. head banging, self-biting, skin picking)
Physical aggression
(e.g. kicking, biting, pulling hair)
Verbal/vocal behaviour
(e.g. verbal aggression, screaming)
Disruption/destruction of property or the environment (e.g. ripping clothes, breaking windows or furniture)
Stereotyped behaviours
(e.g. rocking, spinning, hand flapping)
Inappropriate or unacceptable sexual behaviour (e.g. masturbating in public, touching others inappropriately)
Smearing and urination
(e.g. smearing faeces, urinating in inappropriate places)
Stealing
(e.g. taking possessions/food from others)
Non-compliant behaviour (e.g. refusing to move, refusing to engage in an activity)
Running away

Thank you for taking the time to complete this form.

All answers are strictly confidential.

We will contact you to let you know whether your application has been successful. If you have any questions about the application please get in touch using the contact details below.

Many thanks,

Holly Butcher

CBF Volunteer Coordinator

Please return this form to the Volunteer Coordinator:

By e-mail:

Or by post:

Freepost RRRH-GCJS-BRZJ

The Challenging Behaviour Foundation

The Old Courthouse

New Road Avenue

Chatham

Kent ME4 6BE

Tel: 01634 838739

Web:

Challenging Behaviour Foundation is a registered charity in England and Wales no. 1060714