Make a Referral

We’re excited to have the opportunity to support a child or young person through our program. To get started, we just need a bit of information to help us understand how we can best support them. This will ensure we provide tailored and meaningful mentorship.

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 Outcomes

ID. Know Yourself Referral Form

Eligibility Criteria

The young person I work with is over 12 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 identifies as 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 if the young person lives more than 10km from our facility unless otherwise specified.

Your Details

Referrer Name

First Name

Last Name

Name of your organisation

Referrer Email

Referrer Phone Number

Aboriginal Young Persons Name

First Name

Last Name

AYP Date of Birth

YYYY

Address

Living Arrangements

Who is the young person currently living with?

Carer and/or young person's 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?

Risk of physical harm to self

if yes, please specify below

Risk of physical harm to others

If yes, please specify below

Diagnosis (Clinical/Psychological)

If yes, please specify below

Mobility Challenges

If yes, specify below

Sexualised behaviour

If yes, specify below

Dietary requirements or allergies

If yes, specify below

Medical conditions

Please specify below

Existing court order

If yes, please specify below

Criminal history

If yes, please specify below

Additional Information

Please provide any other relevant details or concerns about the young person that will help us understand how to best support them in the program

NEXT STEPS

Once we receive your referral form, a member of our team will contact you to discuss the next steps and how we can support the young person in our program.

Thank you for taking the time to provide this information.

We look forward to working together!