This application is strictly in line with the charities privacy policy.

All information collected will not be shared with any organisation and will be kept solely for ANAM CARA's evaluations and statistics.

No personal data will be shared at any stage during the process and all personal data will be destroyed within a year.

Applicants must fit within the criteria; women who are;

- Currently experiencing stress, anxiety, depression or low self worth

- At risk of or are using unhealthy coping mechanisms like alcohol, prescription drugs, food or self harming

- Are in a stable place to commit to the programme

- Willing to commit to change.



Please fill out the following form to help us understand your physical condition.

Do you consider yourself a carer?
Relationship Status
Age of Any Depending Children
Employment Status
Armed Forces Connection
Referrer Organisation
Current Support(s)
Family History
Do you experience suicidal thoughts?
Coping Mechanism(s)
I've been feeling optimistic about the future
I've been feeling relaxed
I've had energy to spare
I've been thinking clearly
I've been feeling close to others
I've been able to make my own mind up about things
I've been interested in new things
I've been feeling useful
I've been feeling interested in others
I've been dealing with problems well
I've been feeling good about myself
I've been feeling confident
I've been feeling loved
I've been feeling cheerful

Thanks for submitting!

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