Supporting the Adult Care Workforce in Cambridgeshire and Peterborough with funding and information on social care training.
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I am a Care Provider - please register me now!

This is my application to register for Cambridgeshire and Peterborough Care Brokerage.



Name of parent company (if applicable):
Name of organisation:
Mailing Address for the organisation:
Name of contact person:
Job title of contact person:
Name of person completing this form:
E-mail address of contact person:
Secondary e-mail address
Website address of organisation:
 
Landline:          Mobile:  

We will contact you primarily via email. If you would prefer us to contact you via a different method please choose one or both of the following:

Telephone         post


Section 1 Are any other locations associated with your company?

NO (if 'NO' please go straight to Section 2) YES (if 'YES' please complete Section 1a)
  Care Provider Name (e.g. Hillrise):
 
  Address:
 
  Contact Name and Title:
 
  If you have more than one other affiliated company please list here:
 
 
 

Section 2 What type of provider are you?

Private Voluntary Statutory / NHS Direct Payment / Personal Budget



Section 3 Within what type of service does your organisation operate?

Residential Care Home
Residential Nursing Home
Carers' Support
Day Service Family Centre
Domiciliary Care
Local Authority
NHS Trust
Nursing Agency
Cambridgeshire Community Service
Peterborough Provider Services
Supported Living
Other (please specify):


Section 4 What kind of client group do you work with? Please mark all that apply:

All
Older People (+65)
Adult (other)
Adults who misuse drugs / alcohol
Adults with learning disabilities
Adults with sensory impairment
Older people with dementia
Mental Health Patients
Carers
Children & Adolescents
Primary & Cummunity Health
Other (please specify):

Section 5 Are there any particular areas of training in which you are interested?



Section 6 Approximately how many staff do you employ at your location?



Section 7 How did you hear about Cambridgeshire and Peterborough Care Brokerage? (Choose more than one if appropriate.)

Previous Work Experience
Via Training Provider
Referred by another Care Brokerage (if so please tell us which):
Referred to by Train to Gain
Via another website (please tell us which):
From this website
By attending an event
Other (please tell us more):

Section 8 How can we best serve your organisation's training needs?



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