Streetwork Referral Form

** NOTICE - there is current waitlist of 10 -14 weeks **

The Kickstart mentoring program is our most requested service program delivered as outreach and combines case management with a youth work approach. The program involves working with the young person to set goals that assists them to address the risk factors impacting them and includes connecting them to the specialised youth services to address those risks which may include risks associated with accessing mental health services, school disengagement, securing stable and safe accommodation, legal (police/juvenile justice/court) issues or accessing drug and alcohol supports.

Success is improved when the young person is aware that a referral to our service has been made and that he/she can set goals and develop an action plan, to achieve those goals.

Please note the following:
- StreetWork is operating at capacity, and we therefore have an extensive waitlist with an 10-14 week delay in our intake and assessment process and mentoring services.
- Currently, the client supports we are prioritising are high-risk vulnerable young people with an immediate identified need (linking with an accommodation service, accessing AOD counselling, support to meet with police/juvenile justice, etc)
- Young people with no supports in place.
- We recommend that you pursue other early intervention and prevention programs offered by youth services/organisations.
Before referring to Streetwork we encourage to first exploring a other youth services or local council run youth centre for general youth social and recreational activities.
Referral Form

(Use for referring vulnerable young people to Streetwork's Kickstart Mentoring program)
Are you:*

Young person

Complete this if you are a young person seeking help
I would like help with*

Finding safe and stable accommodationPolice/Juvenile Justice/Court mattersDrug/Alcohol misuseAccessing mental health servicesSchool disengagementDomestic/Family violence
Which of these risk areas is the young person open to address in mentoring (court support, accessing counselling and other services etc) or other identified goals??*
Full Name*

First NameLast Name
Date of Birth*

DayMonthYear
Date
Age*
Address*

Street Address

Street Address Line 2

CityState

Post Code
Best contact for the young person*
email / phone / Instagram etc

Submit Information
Thank you for completing the Streetwork online referral form.

The Kickstart mentoring program is our most requested service program which involves working with the young person to set goals that assists them to address the risk factors impacting them and includes connecting them to the specialised youth services to address these risks.

Success is improved when the young person is aware that a referral to our service has been made and that he/she can set goals and develop an action plan, to achieve those goals. We would appreciate that you discuss this referral with the young person before we make any contact with them.

Please note the following:
- StreetWork is operating at capacity, and we therefore have an extensive waitlist with an 10-14 week delay in our intake and assessment process and mentoring services.
- Currently, the young people supports we are prioritising are high-risk vulnerable young people with an immediate identified need (linking with an accommodation service, accessing AOD counselling, support to meet with police/juvenile justice, etc).
- Those vulnerable with no supports currently in place.
- We recommend that you pursue other early intervention and prevention programs offered by youth services/organisations.
Please click 'Submit' below to send the information you have entered to StreetWork.
Should be Empty:

Referral Form

Young person

Referring Agency or Parent/Carer

Submit Information