Please fill in the form below if you are, or you know of somebody, who wants to apply to become enrolled in DISCO’s programs.

 

Please note: completing this referral form does not ensure automatic enrolment; acceptance into DISCO's programs is subject to an interview, which will be arranged following submission of this referral form.



PROGRAM YOU ARE APPLYING FOR (required):

Jobs through Education & Training (JET)

Youth Employment Support (YES)

Youth Support Coordinator (YSC)

Transition to Work (TtW)


SOURCE OF REFERRAL DETAILS (if applicable)

Name of person making referral:

Referrer's Organisation:

Referrer's Contact Number:

Referrer's Email Address:


PARTICIPANT DETAILS

Participant's Name (required):

Gender (required):

MaleFemale

Address (required):

Post Code (required):

Phone Number:

Mobile:

Email:

Date of Birth:

Reason for Referral (please tick appropriate box/boxes):

ExcludedSuspended from schoolAt risk of leaving school/TAFE prematurelyLeft school earlyTruancyLow literacy/numeracy skillsFamily conflictSubstance AbuseSelf-harming/suicideBehavioural issuesHomeless/Risk of homelessnessBullying/harassmentIndigenousNon-English SpeakingDisabilityDifficulty obtaining employmentDifficulty maintaining employmentOther

Has the participant previously accessed or is he/she currently being assessed by any of the following:

Youth Support CoordinatorSchool NurseBehaviour ManagementCentrelink youth teamHOD Student SupportYear Level CoordinatorCentrelink Social WorkerDeputy PrincipalOther