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Please use this application form to apply for any of the following Abianda Programmes:
· Islington Star Project (for young women/girls aged 13 - 24)
· Elevate
· Young Women's Advisory Group

Islington Star Project
· If you are making an application for our Islington Star Project, the information on this form will be shared with Islington Collaboration Action Network (I-CAN) as the service is run in collaboration with them.
· We only accept applications where a young woman has consented to the application and where there is a named external professional. Where this is not provided, the application will be rejected and no further action will be taken by Abianda.

Elevate and Young Women's Advisory Group
· We can accept both self-applications and organisational applications for these Programmes, but we will only accept applications where a young woman has consented to the application.

All applications
· We will then endeavour to respond to the application form with a decision and next steps within 5 working days of receipt.

IMPORTANT
·    Please be aware that everything captured on this form will be shared and checked with the young woman during the introductory session, in order to confirm that the information about her is correct and to support transparency.
·    On that basis, please only include factual information and your professional concerns that are relevant to the application criteria. We encourage you not to provide a full case history, however, you should provide details as to why our application criteria are relevant to the young woman's circumstances.
·    Please also make sure that the young woman is aware of the information you are including here.

Identity

Young woman's first name

Young woman's last name

Known as/preferred to be called

Preferred pronouns

Young woman's date of birth

Age of young woman

Sex assigned at birth

Gender identity

Sexuality

Ethnicity

Application Information

Type of application

Date of application

What Abianda programmes would you like to apply to? (Please note, we can ONLY accept applications from organisations for our Star Project)

Please provide contact details of other services and professionals that you are / the young woman is working with a the current time

Organisational Contact Information

Reason for application

Young Woman's Contact Information

Address 1

Address 2

Town/City

Post Code

London Borough responsible for young woman

Young Woman - Phone

Young Woman - Email

NOK / Emergency contact name

NOK / Emergency contact phone number

NOK / Emergency contact relationship to young woman

Additional medical information to be aware of (e.g. regular medication taken, allergies/intolerances)

Accessibility

Do you / doees the young woman have any disabilities, long-term health conditions, mental health needs, or learning differences?

What adjustments or support needs should we be aware of which would help you / the young woman to access support?

Ways of Working

Do you / does the young woman have any preferred learning styles?

Do you / does the young woman have a preferred communication style?

Do you / does the young woman have any preferred communication method(s)?

Do you / does the young woman need any support needed for travel (and reason)?

Have you / has the young woman worked in groups before? (Not required for referrals to the Star (1:1) programme).

How do you / does the young woman feel about group work / working in teams? (Not required for referrals to the Star (1:1) programme).

Young Woman Application Form

Identity

Application Information

Organisational Contact Information

Young Woman's Contact Information

Accessibility

Ways of Working

Background

Legal and Financial

Application Consent

Additional Referral Information