YOS Referral form

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YOS Referral form

For young people referred by the Youth Offending Service

This is an initial registration form. Please note, there will be further questions asked in person, before admission.

Young person's full legal name *

Key Information

Please complete this information IN FULL.

Young person's age *

Option 13-16

16-19

19-25 (SEND)

Is the young person presently enrolled in school? *

Yes

If the young person has been excluded from school, please indicate when excluded.

yr7

yr8

yr9

yr10

yr11

Clear selection

Young person's preferred name

Young person's sex *

Male

Female

Young person's gender identity

Date of Birth *

YYYY

Ethnicity (for statistical purposes)

Full address (including post code) *

Young person's contact telephone number

Parent/carer (relationship) contact telephone number *

Emergency contact name, relationship and contact details *

Young person's email address

Parent/carer (relationship) email address *

School

School contact name and details (telephone, email)

Referrer's name and contact details (telephone, email)

Case Worker's name contact details (telephone, email)

Is the young person a Looked After Child (LAC)?

Yes

Clear selection

Cultural / religious needs

Young person's shoe size

(Everyone must wear steel toe cap safety boots in the workshop. Young people have the option to bring their own boots, otherwise, CEO will provide them with a pair.)

Reasons for referral

Please complete this section to the best of your knowledge, involving the young person in the process.

Areas of interest

Plumbing

Electrical Installation

Health and Safety and CSCS card

Employability skills and job search

Simulated work experience

Required

Current qualifications

This question is to be answered by the young person: Why would you like to attend CEO? *

Important Privacy Notice

By signing below you are giving consent to Construction and Engineering Opportunities (CEO) processing the information contained on this form for the purposes of deciding whether to offer you a place at CEO and enrolling you at CEO and with various Awarding Bodies. By signing, you are also consenting to CEO contacting your school, college, parent/carer, youth worker/YOT worker or other agency for further information, where necessary. Our full policy on how your data is used, stored and destroyed is available on request.

Referral date *

YYYY

Young person's signature (type) *

Special Educational Needs and Disabilities (SEND)

Please give details.

Does the young person have any of the following conditions? *

Neuro-diverse conditions (ADHD, Autism etc). If so, does the young person require medication to manage?

Cognitive issues

Speech, language and communication needs

Sensory impairment

Physical impairment

Moderate learning disability

Any other special educational needs and disabilities

Any physical disability (please give details below)

None of the above

Other:

Required

Please give details

Does the young person have a Educational Health Care Plan?
*

Yes (please send a password protected copy via email)

Offence History

Please note that further questions may be asked in person, prior to admission.

Previous convictions (please include a list of all convictions and the date offences committed)

Current Court Order and conditions/requirements (please include any areas and/or people they cannot go or have contact with as a requirement of their Court Order).

YOS assessment of risk of re-offending (include supporting evidence)
*

YOS assessment of risk of harm (include supporting evidence)

YOS assessment of safety and well-being (vulnerability) (include supporting evidence)

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