Referral for Young People who require Targeted Support

Client name / Referrer name
Date of Birth / Referral Agency
Address / Position
Tel No / Referral Tel No
Email / Referral email

Date of Referral: __/__/____

To refer to YES Youth Employability Service for targeted support, the young person will need to identify with at least 1 group within table 1 and one different group from table 2. One of the issues identified must be that the young person is not in education, employment or training. Please indicate which groups.

Table 1

Not in Education, Employment or Training(NEET) / Young Carer
Looked After/In Care / Teenage parent caring for own child
Supervised by YOT / Teenage parent not caring for own child
Care Leaver / Learning difficulties and/or disabilities
Support from Flexible Learning & Education Support Service(FLESS) / Substance misuse
Yr 11 with no September Guarantee / Refugee/Asylum Seeker
Yr12/13 and at risk of becoming NEET on finishing learning / Accommodation Issues
Pregnant / Other

Table 2

Education, Employment and Training / Personal situation and environment
NEET / In receipt of benefits
Gifted but vulnerable / Estranged from family
Non/poor attender / Poor family support networks
Risk of exclusion / Concerns with accommodation/threat of homelessness
Maths and/or English below level 2 / At risk of domestic abuse (family or partner)
English foreign language / CAF in place for client or sibling
Prior unfinished qualification or accreditation / History of family unemployment
Low aspirations/motivation / Lack of independent life skills
Isolated / Complex relationships with others
(family, friends, community)
Low self esteem/confidence / Traveller family
Education, Health and Care Plan or Learning Disability Assessment / Health
Low attainment levels at Key Stage 4 / Physical health
Social / Sexual health
Risk of Offending / Mental Health(not working with CAMHS)
isolated / Alcohol/substance use
Low self esteem/confidence / Emotional wellbeing and identify
Other

Please add further information below, to assist with YES Skills and Employability Team are able to establish if the client will be eligible.

The information you have provided on this form will be held in paper format and on our secure database, which is covered by the Data Protection Act 1998. You have a right to see any information that is kept about you.

I consent to this information being shared with Medway Youth Trust so that I can access the service.

Young person’s signature Date

If consent has not been obtained please state the reason

Please return completed form by secure email to:

Or post to:

Youth Employability Service

11 Cambridge Road

Hastings

TN34 1DJ

Phone 01424 722045 or 01323 410803

Medway Youth Trust is a company limited by guarantee registered in England and Wales, No: 6393997, Registered Charity No: 1124219