Cymru Transitions Referral Aug2013

Dear young person/parent,

RNIB Cymru Transitions Services support young people with sight loss (ages 14 to 25) through their Transitions Officers who work directly with young people and their families.

Our Transitions Officers are here to provide advice and guidance to young people and offer support as you/your child moves from school and onto college, university, or work.

The support we offer varies and is tailored to young people and what they need but it can include things like help accessing voluntary placements and training, advice to make sure you are fully prepared for college or university and help to make sure all your support is in place ready for your start date.

If you or your child would benefit from our input please complete the following forms.

We look forward to meeting you.

Yours faithfully,

Sophie Dyment

Transitions and Employment Team Manager

RNIB Cymru

FORM A (under 18 years old)

Consent for RNIB Transitions Support

IMPORTANT: This form must be completed by the parent or guardian if the young person is under 18 years of age.

Name of parent / guardian:

Parent / guardian address:

Parent / guardian email address:

Parent / guardian phone number:

Name of child / young person:

Child / young person’s date of birth:

Gender:

School or college attended by child / young person:

Please indicate your child / young person’s preferred format e.g large print, email, braille:

Reason for referring to Transitions Officer:

Is there any additional information you feel we need to know?

My signature:

Today’s date:

I have ensured that my child understands the information I have passed to you:

Yes

I understand and agree to be contacted by a third party to provide any feedback and evaluation on the services provided

Yes

I give permission for any photographs or videos taken during the work carried out with my child / young person to be used for the purposes of publicity

Yes

I give permission for the information on this form to be recorded and stored by RNIB Cymru and that I may be contacted again for training courses, events or feedback

Yes

I give permission for you to share the information on this form with partner organisations such as UCAN Productions / Careers Wales

Yes

I give permission for you to liaise with other professionals involved in my child’s transition as necessary

Yes

Statement - I acknowledge receipt of and understand the information above regarding RNIB Cymru and consent for my child to participate in any activities or events and receive support.

Parent/Guardian Signed:

Date:

Relationship to Participant (if applicable, ie mother, father):

Important: We regret that we cannot, in any circumstance, include anyone under the age of 18 without parental/guardian permission.

FORM B (18 years and over)

Consent for RNIB Transitions support

Participant information

My name:

My address:

My email address:

My phone number:

Date of Birth:Sex: MaleFemale

Please tick which applies to you:

I am at school

I am at sixth form

I am in college

I am at university

I am working

I am currently not in education or work

Other

Please provide information about where you study or work if applicable:

Please indicate your preferred format e.g. large print, email, braille:

Reason for contacting our Transitions Officer: