#IAM Girls Club #IAM Girls ClubDo you know a young female aged 13-16 who is at risk, suffers from or has in place any of the below:• At Risk of Exclusion from Mainstream Provision• On an Education, Health & Care Plan with behavioural, emotional and/or social difficulties• Child In Need Plan• Child Protection Plan• Mild SEN• Lacks Confidence/Suffers with Depression or Anxiety If yes, please complete the below referral form. Spaces are LIMITED so please await confirmation that your space has been allocated.New dates coming for 2026 Self-Referral Step 1 of 3 33% YOUR DETAILSYour Name Your Age Do you receive free school meals?YesNoPostcode Contact numberYour Email Reason for referral Any additional support needs i.e. childcare restrictions, health issues, dietary requirements/allergies, learning difficulties etc. SELF ESTEEM SCALEI feel that I am a person of worth, at least on an equal plane with others.* Strongly Agree Agree Disagree Strongly Disagree I feel that I have a number of good qualities.* Strongly Agree Agree Disagree Strongly Disagree All in all, I am inclined to feel that I am a failure.* Strongly Agree Agree Disagree Strongly Disagree I am able to do things as well as most other people.* Strongly Agree Agree Disagree Strongly Disagree I feel I do not have much to be proud of.* Strongly Agree Agree Disagree Strongly Disagree I take a positive attitude toward myself.* Strongly Agree Agree Disagree Strongly Disagree On the whole, I am satisfied with myself.* Strongly Agree Agree Disagree Strongly Disagree I wish I could have more respect for myself.* Strongly Agree Agree Disagree Strongly Disagree I certainly feel useless at times.* Strongly Agree Agree Disagree Strongly Disagree At times I think I am no good at all.* Strongly Agree Agree Disagree Strongly Disagree Participant consent : I agree to my contact details being stored, accessed and used by LUV CIC and it’s subcontractors. I agree I do not agree Preferred delivery method* Online Face to face Participant agreement: I agree to attend each session, at least 5 minutes before the start and contact LUV CIC if unable to attend. I also agree to fully participate in the sessions, without judgement and maintaining confidentially of the group I agree I do not agree I have read and abide to the privacy policy stated in the footer* I have read this policy Δ Refer Someone Else Step 1 of 3 33% YOUR DETAILSYour Name Your Age Do you receive free school meals?YesNoPostcode Contact numberYour Email Reason for referral Any additional support needs i.e. childcare restrictions, health issues, dietary requirements/allergies, learning difficulties etc.Would you like to be part of our Whatsapp groupYesNoThe Whats App group will be other ladies on your course SELF ESTEEM SCALEI feel that I am a person of worth, at least on an equal plane with others.* Strongly Agree Agree Disagree Strongly Disagree I feel that I have a number of good qualities.* Strongly Agree Agree Disagree Strongly Disagree All in all, I am inclined to feel that I am a failure.* Strongly Agree Agree Disagree Strongly Disagree I am able to do things as well as most other people.* Strongly Agree Agree Disagree Strongly Disagree I feel I do not have much to be proud of.* Strongly Agree Agree Disagree Strongly Disagree I take a positive attitude toward myself.* Strongly Agree Agree Disagree Strongly Disagree On the whole, I am satisfied with myself.* Strongly Agree Agree Disagree Strongly Disagree I wish I could have more respect for myself.* Strongly Agree Agree Disagree Strongly Disagree I certainly feel useless at times.* Strongly Agree Agree Disagree Strongly Disagree At times I think I am no good at all.* Strongly Agree Agree Disagree Strongly Disagree Participant consent : I agree to my contact details being stored, accessed and used by LUV CIC and it’s subcontractors. I agree I do not agree Preferred delivery method* Online Face to face Participant agreement: I agree to attend each session, at least 5 minutes before the start and contact LUV CIC if unable to attend. I also agree to fully participate in the sessions, without judgement and maintaining confidentially of the group I agree I do not agree I have read and abide to the privacy policy stated in the footer* I have read this policy Δ