Client Referral Form

Young Leaders Youth Services (YLYS) is a mobile organisation providing supports across Sydney, Illawarra, and the Nepean region, with upcoming expansions into Newcastle, Canberra, Melbourne, and Queensland.

The Client Referral Form can be completed by a responsible guardian on behalf of the young person (e.g. parent, foster carer, caseworker, support coordinator). Once we receive the completed form, a member of our team will be in touch to discuss the next steps.

Client Details

Client First Name

Client Surname

Date of Birth

Date of referral

Gender

Male Female

Living Arrangement *

At Home with FamilyFoster CareOOHC/ SIL or TSILOther

Address

Referral Information

Reason for referral

Service Required

Funding Options & Eligibility Criteria

Young Leaders Youth Services (YLYS) provides mentoring and disability support programs for young people aged 7–26 of all abilities. Our services are designed to empower youth through personal development, community engagement, and wraparound supports.

Eligibility Criteria

To access our supports, young people must meet at least one of the following:

Be an NDIS participant with approved funding under relevant support categories.
Be referred through a Labour Hire Agreement or Service Contract via an organisation or agency (e.g. DCJ, OOHC providers, NGOs, youth services, or schools).
Be privately funded by a family, carer, or guardian.

We currently support:

NDIS Participants: Ages 7–26 (Plan-Managed or Self-Managed)
OOHC Participants: Through caseworker or agency referral
Community Participants: Through self or family referral (private funding)

Select required services *

Youth NDIS Support?Youth OOHC Support?Youth Community Support?

Comment

Referrer details

Name

Organisation

Phone

Relationship to client above

Email Address

Additional Information

Signature

Draw signature|Type signatureClear