Mentoring sign up

Cleft ++

Connecting young people born with a cleft aged 12-17 with trained mentors

About Mentoring

Who is the service for?

Young people born with a cleft aged 12-17 who would like to talk to someone else born with a cleft. We know that having someone to talk to who shares life experiences can be really valuable; your Mentor will know what it's like to go through surgery, make decisions about cleft treatment, and share their experiences of how they have dealt with questions and negative comments about their cleft. They will be able to relate to feelings you might have about your cleft, and we think that talking through how you feel with a trusted adult will help you become more resilient, feel positive, and better cope with cleft-related challenges.

Is this the right time for you?

Mentors aren't trained therapists or medical professionals. If this kind of help is more what you need, please get in touch with us anyway, as we would really like to help you get the support you need. If now isn't the right time, you can come back at any time in the future.

Keeping everyone safe

It is our job to make sure you and your Mentor stay safe. This is why all conversations will happen on Brightside, a mentoring platform. This lets you and your mentor communicate without sharing personal details like your contact information. The platform will freeze messages with risky words until a CLAPA staff member can check the content and ensure it is safe to pass between Mentee and Mentor.

How it Works

Mentoring is about being safely guided by a trusted person, using mentoring tools and techniques to move towards goals and targets. The first couple of weeks are about getting to know each other and building trust. Your Mentor will share experiences with you that you might be able to relate to, we hope that this will help you feel that you aren't alone in what you are going through and by sharing how you feel with your Mentor, you can make plan together to help you move forward and finish mentoring feeling stronger and more positive.

Signing Up

Make sure to give us as much detail as possible about any support needs you might have so that we can support you to get the most from your mentoring experience. There is a section at the bottom of the form for your parent/carer to fill in so we know they are happy for you to take part.

Confirming your place

We will send a confirmation email when you are accepted.

We'll then send you:

A guide to mentoring

An invite to join a CLAPA staff team member on zoom, so we can chat a little about you and about mentoring and make sure this is the right place for you

A video guide to using Brightside, the mentoring platform we will use for all communication between you and your Mentor

Some details about the Mentor you have been matched with

Young people of all backgrounds, races, religions, genders, sexualities, and differences are welcome at all CLAPA services. If there's anything we can do to make you feel comfortable and welcome, please let us know when you sign up (there's a space on the form to do this).

Safeguarding at CLAPA

If you have any worries, thoughts, or questions about anything at any time, we are here to listen and support you. Safeguarding means protecting you from harm. It is our job at CLAPA to keep you as safe as possible. If you feel unhappy or uncomfortable, please reach out to your Mentor or a member of the CLAPA staff.

Find out more about how we keep children and young people safe at all CLAPA events.

How CLAPA Uses Your Data

We collect and store the information you provide in this form in order to sign you up with the Cleft ++ Mentoring Service and keep in touch with you before, during and after. We'll store this information on our secure database, but only a small number of staff with special training and background checks can access it. We won't share your personal information with anyone or any other organisations unless we need to in order to run this service or we have a safeguarding concern.

We keep everything secure in line with our data protection policies. For more information, see our Privacy Policy.

About You

What is your connection to CLAPA?

Young person (under 18) born with a cleft

Your Name*

First Name

Last Name

What name should we use when contacting you?

My first name Another name

What other name should we use when contacting you?

Your Email Address*

If you don't have an email address, you can use a parent or carer's email address

Your Home Address*

Address Line 1

Address Line 2

City

Postcode

Your Date of Birth*

Your Age*

To keep everyone safe, we need the details of a parent or carer, a second trusted adult (such as another parent/carer or relative), and your GP.

Parent or Carer's Name*

First Name

Last Name

Parent or Carer's Email Address*

Parent or Carer's Phone Number*

Name of Trusted Adult*

First Name

Last Name

Trusted adult's relationship to young person*

e.g. 'Grandparent'

Trusted Adult's Phone Number *

Trusted Adult's Email Address*

Name of GP surgery*

First Name

Last Name

GP Address*

Address Line 1

Address Line 2

City

County/Region

Postcode

You and your mentor

Tell us a bit about yourself - your hobbies, interests and anything else you would like to share*

If you are accepted onto the program, this will help us to make sure we match you with the right mentor

What is the biggest challenge you would like to talk about with your mentor?*

Is there anything else you would like to talk to your mentor about?*

What do you hope to achieve from having a mentor?*

What is the change you want to see

Is there anything we should know which could help us support you to get the most out of mentoring?*

You could tell us about any learning needs you have, mental health difficulties, stressful life situation

Are you receiving support form any other organisations?*

Yes No

It might be that you have spoken to your GP or a counsellor, a cleft psychologist or someone else who is helping you in your life. It's useful for us to understand this before we match you with a mentor

Which organisation(s) are supporting you?*

Please note: we will invite all young people applying to our Mentoring Project to a pre-mentoring chat via zoom. Claire, from the young people's team, will be in touch with you to arrange this.

I confirm that, to the best of my knowledge, I have given accurate information about myself and my support needs and my reasons for signing up to mentoring*

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Use your mouse or finger to draw your signature above

Parental consent and support for you to take part in mentoring

If you are aged 14-17, we would like to know that your parent (or the adult responsible for you) is involved by asking them to sign below, but this is not mandatory. Please note that your parent/carer will get a confirmation email to let them know you've signed up for this service even if you don't get them to sign below.

If you are aged 12 or 13, we need to have consent from your parent for you to be able to take part. They will need to sign below before you can start the programme. If you sign up without having them sign below, we will contact them directly to get their consent for you to take part.

I confirm that I will inform CLAPA immediately should any of the above information change.

Please sign below to confirm that you have parental responsibility for the named young person and consent them to join CLAPA's mentoring service, where they will receive 1-1 mentoring support from a trained CLAPA volunteer via Brightside, an online mentoring platform for young people.

Parent or Carer: I agree to the above

Yes

Parent or Carer: Signature

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It's important that your parent or carer signs here to let us know that they are happy for you to join us at this event. Please use your mouse or finger to draw your signature above.

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