Make a Referral

All information collected below will be kept confidential and is used by our team to determine if, and how we can best support the young person you’re referring. Before you get started, you can read more about our program and eligibility requirements below

Program

ID. Know Yourself Referral Form

Eligibility Criteria

The young person I work with is over 7 yrs old and under 17 years old.

The young person I work with lives within the Greater Sydney Region.

The young person I work with is Aboriginal.

I understand that I will need to seek funding approval for young person to attend this program.

I understand that it is my responsibility to organise transport to and from group sessions unless otherwise specified.

Your Details

Referrer Name

First Name

Last Name

Referrer Email

Referrer Phone Number

Aboriginal Young Person Details

Your relationship to AYP

If you're a case worker or support worker please include the name of the organisation you work for and/or your service area.

AYP Name

First Name

Last Name

AYP Date of Birth

YYYY

AYP Address

With who?

Who is the young person currently living with?

Carer and/or AYP Phone Number

(###)

###

####

Do you know the young person's cultural background?

Name of Mob/s

If unknown, please include the last name from the young person's Aboriginal side of the family, and/or details of where you're up to in the investigation.

Are there any situations or behaviours where the young person might need extra support, in order to keep them or others safe and strong?