Yilaan.Gaal Dhina - Fresh Footprints

  • Fresh Footprints Referral Form

    Please complete this referral form with the client’s details, consent, needs, risks, background, goals, and support request.

  • Consent and Referral Details

  • Has the young person consented to this referral?*
  • Does the client agree to Fresh Footprints contacting them directly?*
  • Does the client agree to their information being stored by the Tamworth Local Aboriginal Land Council?*
  • Date of Referral*
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  •  -
  • What can the referring agency support the client to obtain?

  • Client Details and Identity

  • Client Date of Birth*
     - -
  •  -
  • Does the client identify as
  • Does the client have

  • Referral Reason, Needs, and Safety

  • Does the client require any of the following support?*
  • Are there any immediate safety concerns?*
  • Is there any current substance use?*
  • Is there an intoxication or withdrawal risk?*
  • Is the client's substance use impacting safety, housing, or family?*
  • Has the client had any interaction with the justice system?*
  • Has the client been incarcerated?*

  • Medications, Education, Qualifications, and Employment

  • Does the client take any medications that affect or are likely to affect their work capacity?*
  • Highest level of schooling
  • Tickets / licences held
  • Current Employment Status

  • Interests, Goals, and Support Request

  • Client interests
  • Industries of interest
  • Should be Empty: