Expression of Interest

If you, or someone else, wants to receive support from Pyxis, please fill out our Expression of Interest form below.

Please note, Pyxis is currently only taking referrals for:

1:1 Mentoring
Our 18-25 Pyxis.Social group (if the person is a woman, is transgender, or non-binary. For more information about this, please see our recent post here).

HOW THIS FORM HELPS US

This expression of interest form is designed to give us an idea of how the referred person finds social situations. With this information we can think about the projects they may be suitable for and how we might consider their needs in our planning.

WHAT HAPPENS AFTER I SUBMIT THIS?

We follow up on all expression of interest submissions via phone, text message or e-mail to discuss your young person in more detail, so please ensure that your contact details are accurate. We aim to respond to all enquiries within 7 days. If you have not heard from us within this time, please check your spam folder for our email.

Name

First Name

Last Name

Phone

(###)

###

####

Are you a parent/carer, professional, or someone wishing to access the service?

Location

Where did you hear about us?

If you are a professional, does the referred person's family consent to this referral?

Yes

Referred Person's Full Name

Date of Birth

YYYY

Is the referred person aware of this referral?

If yes to the above question, what is their opinion on accessing our service?

Is the referred person at school, college, home educated, employed, or volunteering?

If yes to the above question, please state which school, college, employer or organisation.

In terms of their social understanding and interaction, how would the person find their place of education or work?

Please comment on both what they find easier and what they find more difficult.

In terms of their social understanding and interaction, how would the person find being at a family party?

Please comment on both what they find easier and what they find more difficult.

In terms of their social understanding and interaction, how would the person find being in a public place?

Please comment on both what they find easier and what they find more difficult.

What does the person enjoy?

What don't they enjoy?

Do they have a diagnosis of an Autistic Spectrum Condition? Are they awaiting assessment for a diagnosis?

Are there any other services involved with the person? If so, please tell us which services.

How is the referred person supported in their life, social or employability skills by their place of education or employeer?

Does the referred person have any disabilities, medical conditions or allergies we would need to be aware of?

Please let us know which projects you are referring to:

18 - 25 Pyxis.Social Group

Pyxis 1:1 Mentoring

Please use the space below to give us an indication of what you and the referred person are hoping Pyxis can support you with.

Would you like your referral to be considered for The Barron Fund?

The Barron Fund is made up of money donated to Pyxis for the use of funding Pyxis support for those young people and families that would otherwise not be able to afford it. For more information, click the link to "The Barron Fund" in the menu bar at the top of this page.

Yes