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Youth Support Program Referral Form

///Youth Support Program Referral Form
Youth Support Program Referral Form 2017-04-20T12:35:52+00:00

Youth Support Program (YSP)

Youth Support Program (YSP) supports young people who are at risk of disconnecting from family, community, school, training and employment. This includes working with young people who are at risk of self-harming, homelessness and substance misuse. YSP aims to assist young people to improve their capacity to develop independent living skills as well as improving their overall health and wellbeing.

YSP provides a free and confidential service to Young People aged 12-18 years within the Cairns Region.

Youth Support Program

YSP provides Centre Based Support, Case Management, Outreach and Virtual Support.

Contact Details

Office Hours are 8.30am to 5pm Monday to Friday, no appointment is necessary. 

Outreach is conducted three (3) nights per week, Tuesday, Wednesday and Thursday throughout the community. For more information contact the Youth Support Program. 

Address: 149 Bunda St, Cairns
Phone: 07 4080 5800
Fax: 07 4031 4345
Email:
Download Form: Download PDF YSP-Referral Form

Complete the Youth Support Program Referral Form Online

CLIENT DETAILS
Client Name: *
Client's Age: *
Client's Date of Birth: *
Client's Phone Number(s): *
Client's Address: *
Client's Gender: *
Client's Culture: *
PARENT/GUARDIAN/CARE PROVIDER DETAILS
Name: *
Age: *
Date of Birth: *
Phone Number(s): *
Address: *
Culture: *
REFERRING AGENCY
Department / Agency: *
Program: *
Case Worker: *
Case Worker Phone Number(s): *
Fax (work):
Email Address: *
List other service(s) involved in care team: *
Please indicate who will be lead support provider: *
INFORMED CONSENT
Does the client know they are being referred to YSP? *
Verbal Consent Provided: *
CONTACT ISSUES
(e.g. Can this person be contacted at home or by phone? How do we contact the person?) *
PRESENTING ISSUES
Tick the relevant box(es): *
Provide Details of Presenting Issues: *
ACCOMMODATION
Tick the best description of the young person’s accommodation situation: *
Who does this person live with? (include all persons present in the house and their relationship to the young person) *
SUPPORT REQUIRED
How do you see YSP supporting this person? What are your expected outcomes as the current support agency / provider? Will YSP support be complimentary? *
Please Use This Space To Provide Further Information:
Enter code:

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