Targeted Support Referral Form

Referrers Name*

Professional status*

Referrers Phone Number *

Referrers Email*

example@example.com

Referral Date*

Date

Name*

First NameLast Name

Preferred name (if different to the one above)

Date of Birth*

Date

Gender identity*

Preferred Pronouns

Ethnicity (e.g., White British, Black Caribbean)*

Address (YP)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Contact Details for YP*

SEN, Medical or Dietary Needs*

Parent/Carer Contact Details*

Year group *

Attendance %*

Please tick the most relevant.

YP 16-19 yrs. who are Not in Education Employment or Training (NEET) or up to 25 with a current Education, Health, or Care Plan (EHCP)YP being at High Risk of NEET – Years 11, 12 or 13 (Please see guidance notes)YP experiencing Significant Issues 13-18yrs and in need of additional targeted support

Please tick all additional factors which apply to the young person’s current situation

Are other professionals working with the Young Person or Family?

Professionals Name & Contact Details

Has there been a recent assessment completed?

If yes, please upload here

Referrers Comments - Why is Targeted Support needed? What support has been tried?*

Referrer signature*

Young person’s comments – What support would you like from us?*

Signature

The young person has consented to the referral*

Yes

How would you like us contact you?

MobileEmailvia Parentvia School

Please verify that you are human*

Guidance Notes

Targeted Support is available for young people resident in B&NES aged 13-19 (up to 25 with a current EHCP) and can be provided through individual 1:1 support, group work or brief interventions/signposting depending on the assessed needs of the young person. The service is part of the Early Help strategy and will support young people who have an identified need and who are at risk of experiencing poor outcomes, particularly those who aren’t already engaged with alternative local support.

We support young people to move successfully into adulthood by raising their aspirations and confidence and by building their resilience so they can participate in education, employment or training and improve their general wellbeing.

Our Criteria

Young people who are Not in Education, Employment or Training (NEET)

YCSW provides support to young people living in Banes who are aged 16-19 or up to 25 if they have a current EHCP and are not eligible for other services.

Young People being at High Risk of NEET

YCSW provides support to young people who are at significant risk of leaving education without a progression plan. This support is for young people who are in years 11, 12 or 13. Please note that they will need to meet a minimum of 3 of our other criteria to be considered. If referring for at High Risk of being NEET, please include what your educational establishment has already done to support the young person in gaining a progression plan. This service is for young people living in B&NES. If they are in year 11 and live outside of B&NES but are educated within, they may be eligible for a short intervention support service for transition purposes, (if they meet our criteria). Please contact us to discuss further.

Young People experiencing Significant Issues

YCSW provides support to young people living in B&NES who are aged 13-18 and are in need of 1:1 targeted support. Please include the main areas of concern and what support you think the young person needs.

Consent

We require all our referrals to be discussed and agreed with the young person (and parents/carers if under 14 years old). Our work is based on voluntary engagement and participation of the young person so their input and agreement to the referral is very important.

If you wish to discuss any referral, please email youth_connectreferrals@ycsw.org.uk or call 01225 396980 leaving your contact details and one of our team will get back to you.

Data Protection

The information collected by Youth Connect South West will be processed to provide you with support. Your personal data will be processed in accordance with the Data Protection Act 2018 (GDPR) and will only be shared in accordance with your consent, subject to wider statutory safeguarding and legal responsibilities. For further information on YCSW please contact the team on 01225 396980. The privacy notice is available on the YCSW website.

Youth Connect South West - Targeted Support Referral Form

Referring Agency

Young Person’s Details

Current Education Setting

Reasons for Referral