Apply for a Gateway card

The information you provide will be used to issue a Gateway Card.

Your information will be held on a database until the child or young person is 20 years old for monitoring and information purposes, and to help Hampshire County Council meet the needs of children and young people with disabilities and/or additional needs.

For more information about how the Procurement, Commissioning and Placements Team will use any personal information that you supply read the Privacy Statement.

Child's details

• Child's first name(s) required
• Child's surname required
• Child's date of birth required

  • Day (d)
  • Month (m)
  • Year (yyyy)
  • Age

  For example: 31 12 2005. Note: To be eligible for a Gateway Card, the child or young person must be aged 0-17 years old.

• Child's school, college or early years provider (please enter NA if not applicable) required
• Does your child have any of the following? Tick all that apply required

  • • an autistic spectrum disorder
    • a learning disability
    • a physical disability
    • a sensory / visual impairment
    • complex health care needs
    • challenging behaviour linked to the child's disability
    • other disability or requirement
• If your child has challenging behaviour, give brief details
• If your child has a disability and/or additional requirements other than those listed above, give brief details

Choosing your Gateway Card

There are two different options depending on what you want to use your card for. Please choose one. You will need to submit the correct evidence for either card.

1. 
   If you want a card to evidence that your child or young person has a disability and requires support when visiting attractions or taking part in community activities, you should apply for a Gateway Card.
2. 
   If your child or young person has a disability and needs support to attend a Hampshire County Council funded Short Break Activity (specialist or mainstream), because you need a break from caring, you should apply for a Gateway Card+.

• What type of card are you applying for? required

  • Gateway Card
  • Gateway Card+

Evidence

• What are you providing as evidence of eligibility for a Gateway Card? required

  • A letter from family's General Practitioner (GP), Paediatrician or Health Visitor
  • A letter from Child's Teacher/Special Educational Needs Coordinator (SENCo)
  • Evidence of being in receipt of Disability Living Allowance (DLA) or Personal Independence Payment (PIP)
  • Education, Health and Care Plan (EHCP)
  • A letter from a Social Worker or Professional from Child and Adolescent Mental Health Service (CAMHS), involved with the family
• What are you providing as evidence of eligibility for a Gateway Card+? required

  • A Personal Independence Payment (PIP)
  • Receipt of Disability Living Allowance (DLA)
  • An Education Health and Care Plan (EHCP) that demonstrates how your child needs support to attend a short break activity
  • A referral from a social worker, proof of yellow card
• Is your evidence in an electronic or paper format? required

  • Electronic
  • Paper
• Choose file required

Parent/carer details

• Parent/carer's first name(s) required
• Parent/carer's surname required
• Address

  • • Postcode
    • Ready Find address
  • No results found
  • If you live outside Hampshire, or cannot find your address, manually enter your address
  • • House number or name required
    • Street required
    • Town required
    • County optional
    • Postcode required
• Telephone number optional
• Email address required

Declaration

• required
  My child has a disability and lives in Hampshire (excluding Portsmouth, Southampton and the Isle of Wight)

Help us to improve our service

The following information will help us plan and develop the short breaks programme.

• Select whichever applies if your child receives Disability Living Allowance (DLA) for care optional Please select... not eligible lower rate middle rate higher rate
• Select whichever applies if your child receives Disability Living Allowance (DLA) for mobility optional Please select... not eligible lower rate middle rate higher rate
• Child's gender optional

  • Male
  • Female
• Child's ethnicity optional

Keeping you informed

We would like to keep you informed about our short breaks programme, and notify you with details of activities that your child or young person may benefit from.

• Would you like us to send you updates? required

  • Yes
  • No

More information

If you would like more information, email [email protected]  or phone 03707 793569.

Procurement, Commissioning and Placements Team
Hampshire County Council,
Integrated Procurement, Commissioning & Placement Team,
Children's Services Department,
Elizabeth II Court North,
The Castle, Winchester, SO23 8UG

• Ready Submit