S&CY Program Referral Form

Refer a person in need

The Safe & Connected Youth Program emphasises restoration, reunification and reconciliation between young people under the age of 16 and their families. The Program works to support young people and families to provide a positive and nurturing environment. We work to improve parent-child relationships to reduce risk of homelessness and empower young people to develop their full potential as individuals, as well as contributing to our community.

Safe & Connected Youth Program is a collaborative service comprised of: Conflict Resolution Service, Northside Community Service, Woden Community Service, Marymead, and the Youth Coalition of the ACT. Information provided to the Safe & Connected Youth Program will be shared amongst these partner organisations.

If this referral is for someone 16 or older (or turning 16 in less than 6 months), please use the Family Support Program referral form, which can be found here

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    DETAILS OF YOUNG PERSON

  • DETAILS OF PARENTS/CARERS

  • Does the Parent/Carer understand and agree to this referral?
  • DETAILS OF REFERRER

  • PROFILE OF THE YOUNG PERSON AND FAMILY

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