Client Referral Form

Young Leaders Youth Services (YLYS) is a mobile service delivering supports across Sydney, the Illawarra, and the Nepean region, with planned expansion into Newcastle, Canberra, Melbourne, and Queensland.

We provide inclusive supports to children, young people, and adults aged 7–30, of all abilities and genders. The Client Referral Form may be completed by a participant’s responsible guardian, including a parent, foster carer, caseworker, or support coordinator. Participants aged 18 years and over who are self-managed or plan-managed under the NDIS may also complete the form on their own behalf.

Once the referral form is submitted, a member of our team will contact you to discuss the next steps.

Participant Details

Participants Name *

Date of Birth

Participants Address

Living Arrangement *

At Home with FamilyFoster CareOOHC/ SIL or TSILOther

NDIS Number

NDIS Plan Start Date

NDIS Plan End Date

Diagnosis

Referral Information

Reason for referral

Service Required

We provide mentoring and disability support services across Sydney, the Illawarra, and the Nepean regions. As a mobile service, we come to you.

Our services are available to NDIS participants, young people in Out of Home Care (OOHC), and the wider community. Not being NDIS-funded does not prevent someone from accessing our supports. For referrals involving OOHC, services can be arranged through labour hire in partnership with the referring organisation and the Department of Communities and Justice (DCJ). For parents or foster carers seeking support, we also offer private funding options. Schools and community organisations are welcome to contact us to discuss facilitating programs and workshops tailored to their students or community.

Select required services *

NDIS SUPPORT? OOHC SUPPORT? COMMUNITY SUPPORT?

Comment

Referrer details

Name

Relationship to the participant listed above

Organisation (If applicable)

Support Coordinator (If applicable)

Phone *

Email Address *

Where did you hear about us?

Signature

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