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Pronouns of young person
Date of Birth
Day
Month
Year
Has the young person or their guardian given consent for this referral? (Yes/No)
Yes
No
Does the young person identify as:
LGBTQ
Neuro-diverse
Disabled
N/A
Does the young person have an EHCP? (Yes/No)
Yes
No
Does the young person attend school/college/training?
Is the young person working with any other support services? (tick all that apply)
Ethnicity:
Black
Asian
Mixed Heritage
White

Referral

This referral form is for professionals to refer a young person aged 14–19 to our Alternative Provision programme, delivered by Proud to Be Me CIC in Lewisham.

Reflections is a trauma-informed, inclusive, and culturally competent programme supporting young people who are:

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  • NEET (Not in Education, Employment or Training)

  • Disengaged from school or at risk of exclusion

  • Have an EHCP (Education, Health & Care Plan)

  • Experiencing low confidence, poor self-esteem, or mental health challenges

  • Girls, trans girls, non-binary, or part of the LGBTQ+ community.

  • ​

The programme currently runs 10:00 AM to 3:00 PM, offering a safe, supportive environment where young people can build confidence, explore identity, and re-engage with learning.

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Cost: £220 per student, per day

Location: Lewisham

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To enhance outcomes and provide targeted specialist support, the following therapies can be commissioned alongside the placement:

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  • Counselling: £120 per session (2 sessions per week recommended)

  • Speech & Language Support: £110 per session (2 sessions per week recommended)

  • ​

Referrers can:

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  • Commission the recommended 2 sessions per week

  • Reduce to 1 session per week

  • Or opt out of therapies, depending on assessed need and available funding

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These supports are designed to strengthen emotional wellbeing, communication skills and overall engagement in education.

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Please complete all sections of this form. Once submitted, a member of our team will follow up with you to discuss the placement and next steps.

If you have any questions before submitting, contact us at hello@proudtobemecic.org

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