Support Networks Individual Packages

Support Networks Individual Packages

This program includes individualisedfunding packages for a young person with a disability (18 – 25 years) and their families to use to implement their plan for establishing, building and maintaining social and support networks, and connectivity with their community.

Funding can be used to:

• Pay for enrolment fees for a young person (18 – 25 years) to join their local sporting team;
• Purchase equipment for the young person to join in activities in their local community;
• Access social and personal development group programs run through local youth services;
• Assistance with transport costs;
• Cover course fees for enrolling in educational course/personal development;
• Pay for staff to support the young person to access everyday community based activities alongside their peers (e.g. attending a concert, entertainment venues, football games);
• Purchase a Northcott facilitated partnership event/activity;
• Pay of gym membership, dance classes, music classes, and recreational activities.

Referrer Details

Name and position:

Agency:

Telephone:

Email:

Date of referral:

Does the young person consent for referral, including understanding that Support Networks may contact them for further details about this referral if required: □NO □ YES

Details of person with Disability

Name:

Gender:

Date of birth:

Address:

LGA:

Telephone:

Primary Disability:

Other Disability:

Aboriginal or Torres Strait Islander: □ABORIGINAL □TORRES STRAIT ISLANDER

□BOTH □NEITHER

Interpreter Required: NO YES (specify)

Family Details – please specify where relevant

Primary carer:

Date of birth:

Address:

Telephone:

Email:

Other parent/carer:

Address:

Telephone:

Email:

Please indicate which of the following appliesto the young person to assist with priority:

The following information will be used to guide the request for support.

Please list the other services you are linked with:

• ______
• ______
• ______
• ______

How would you use your individual package?

□Community Based activities

□Recreational Support

□Group programs/events/workshops

□Family Social Events

□Educational/Personal Development

Goals (please expand on above)

1. ______

1. ______

1. ______

Please return the completed form to the Support Networks Coordinator

Post:

Attention: Julie McDonald

Northcott

Po Box 119

Mayfield NSW 2304

Email:

Your referral will be acknowledged within 7 days.

Should you wish to discuss your referral or if you have any other enquiries, please call the Northcott office and ask to speak with Julie McDonald on 4935 0400.