Learning Disability Engagement Platform for Individuals

18th November 2021

Name of the individual*
First Last
Individual's contact number
Individual's email (if available)
Trust area
Name of person supporting/ registering on behalf of the individual (if applicable)
First Last
Support person's contact number
Support person's email
What are the best ways for you (for the individual) to be able to be involved?
- Using zoom
- Using Whatsapp
- Face to face in a group discussion
- Face to face in a one-to-one discussion
- Other
(please specify)
Do you / Does the individual work best with:
- Talking
- Writing
- Pictures
- Symbols
Tell us a bit about any groups you/ the individual joined before now, and why you/ the individual would like to join this group?

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