Amour Destiné - Destiny Creator Referral form
About The Destiny Creators Mentoring Programme:

The Amour Destine - Destiny Creators Mentoring Programme, is a 1:1 and group mentoring programme, that aims to improve the health and wellbeing of black/black mixed race women over the age of 18 born of African & Caribbean heritage in London. We aim to achieve this by helping women affected by traumatic care experiences or domestic abuse & sexual violence, work towards building the lives they desire. By providing a supportive environment for females to develop the self-esteem, confidence, and belief needed to grow in the career or business paths of their choosing. And build bright futures, regardless of their background or circumstances.

The Destiny Creator Programme is free to attend a referral is required.

Where necessary, females may be signposted to external training opportunities and wellbeing support services.

Please complete this form if you have been referred/referring a women to join the programme waiting list so that we can get to know more about them before we start working together.

If you have any questions not found in this form that you would like to ask us, we would love to hear from you, get in touch by emailing:
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Email *
What's your first name? *
What's your last name? *
What is the best phone number to reach you on? *
Which project are you accessing? *
Is this your first time using this service? *
Do you have a child/ren? *
What's your address? *
What has brought you to join the Destiny Creator Mentoring Programme? *
What do you hope to get out of the Destiny Creators Mentoring Programme? *
Is there anyone else supporting you with this problem? *
If there is anyone else working on this issue with you please let us know more details about them *
What do you hope to get out of the Destiny Creators Mentoring Programme? *
Would you be happy to take part in a case study if requested? *
Do you have No Recourse to Public Funds? *
Are you in receipt of any benefits, if so please let us know below? *
We would love to know how you found out about the Destiny Creators Mentoring Programme? *
Are you in paid employement? *
Do you require support with legal fees? *
Do you have any outstanding debts? If yes we will send you a follow up form to complete by email. *
What is your ethnic origin? *
Let us know which age category you are in? *
Do you have any disabilities? If so we will send you a follow up form by email to get to know abit more about you so we can properly support you. *
Are you a care leaver?
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Are you a survivor of domestic abuse, sexual violence or economic abuse?
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As an applicant to become a member of Amour Destine CIC - Destiny Creators Mentoring Progamme, by submitting this form I consent to the processing, retention and sharing of my personal data submitted with my application to join the Destiny Creators Mentoring Progamme, for the purpose of assessing my membership application. I understand that I may withdraw my consent and request erasure of my data at any time prior to your acceptance of my membership. Processing is necessary for statistical purposes in accordance with the requirements of the law of the United Kingdom.  Such statistical data will be anonymised. You will receive a response to your application within 5 working days. Please click on the 'submit' button below to send us your answers.  
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