Online Request Form – Legal Entitlements and Problem-Solving (LEaP) Project Cerebra > Help and Information > Law and Rights > Ask for help from our Legal Entitlements and Problem-Solving (LEaP) Project > Online Request Form – Legal Entitlements and Problem-Solving (LEaP) Project If you would like to ask for support from the Project, please read our Guidelines first and then complete the form below. If you have any questions, you can contact us at firstname.lastname@example.org or on 01267 242582. If you are human, leave this field blank. Title * Mr Mrs Miss Ms Dr Forenames * Surname * Address * Postcode * Email Address * Phone Number * Please enter your area code and phone number without spaces Your Child's Details Full Name * Date of Birth * Please enter as dd/mm/yyyy e.g. 21/12/1956 Medical Conditions * Your Concerns Name of relevant local authority or NHS body * What do you think they did wrong or failed to do? * Describe how your family has been affected * What do you think should be done by the relevant authority to put things right? * Have you raised your concern with the relevant body? If so, how and when did you contact the authority and what was its response? * Cerebra is committed to protecting and respecting your privacy. We will use the information you have provided to process your request and, where appropriate, to help you deal with the issues you have recorded on the form. To help us to do this, we will share your information with colleagues at the School of Law, University of Leeds, who work with us on the Project. We may also use anonymised data for research purposes connected to the Project, for example to write reports highlighting the type of problems that families face. We will store your details electronically and keep it secure. We will not sell or share it with third parties. We will keep your personal data for no longer than is necessary for the purposes described above. Please tick the box below to give us permission to use your personal information in this way. You can withdraw your permission at any time by contacting email@example.com. For more information about your rights under data protection legislation, including your right to make a complaint to the Information Commissioner’s Office, please visit ico.org.uk/for-the-public If you have any queries about how we handle your personal information, please contact us at firstname.lastname@example.org Agree * I consent to Cerebra using my personal information for the purposes described above. Are you human?