Private (Foster Care/Residential Care) Area: Looked After (Other) Please State: Leaving Care How did you hear about Dorset Mind’s Young (Please give specific details) People Services? Please give us the following details about the young person: School: Tel: Training: Tel: Employment: Tel: NEET: Other: Referrer’s details: Name of Agency professional: name: Family Referred Address: Position of referrer: Contact Tel No: Mobile: E-mail Address: Please note any child protection/safeguarding issues and interventions: Please (Please give details of professionals involved, dates, etc.) CP (If applicable) Detail CAF CIN Other 1) Please tell us a little about this young person and how they might benefit from Befriending? (This might include aspects about their personality, likes, strengths, interests, whether they are quiet, shy, etc.) 2) Please tell us about how this young person interacts with other people? (This might include whether they are trusting, open, guarded, resistant or likely to become dependent slowly or quickly.) 3) Please describe how much formal and informal support this person receives (Please provide more information about the nature and possible risks or needs associated.)
Private (Foster Care/Residential Care) Area: Looked After (Other) Please State: Leaving Care How did you hear about Dorset Mind’s Young People Services? (Please give specific details) Please give us the following details about the young person: School: Tel: Training: Tel: Employment: Tel: NEET: Other: Referrer’s details: Name of professional: Family Referred Agency name: Address: Position of referrer: Contact Tel No: Mobile: E-mail Address: Please note any child protection/safeguarding issues and interventions: Please (Please give details of professionals involved, dates, etc.) Detail (If applicable) CP CAF CIN Other 1) Please tell us a little about this young person and how they might benefit from Befriending? (This might include aspects about their personality, likes, strengths, interests, whether they are quiet, shy, etc.) 2) Please tell us about how this young person interacts with other people? (This might include whether they are trusting, open, guarded, resistant or likely to become dependent slowly or quickly.) 3) Please describe how much formal and informal support this person receives (Please provide more information about the nature and possible risks or needs associated.)
Dorset-Mind-YP-Befriending-Client-Referral-Form.docx