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Youth Housing And Reintegration Service - QYS Program

YHARS Client Referral Form

YHARS CLIENT REFERRAL FORM(Required)

Referrer Details

MM slash DD slash YYYY

Details of Young Person

Your Name
MM slash DD slash YYYY
Address
Gender:
Does the young person identify as:

Consent obtained from young person:(Required)
Transitional plan with Child Safety?
Risk Assessment
Eligibility
Please note: At least one box from the "eligibility" section must be applicable to be eligible to receive YHARS Support.
Homelessness indicator
Interpersonal relationships
Financial
Accommodation
Employment Education
Health
Other

Income

Employment status
Student / training

Empowering youth since 1978

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Australian Aboriginal Torres Strait Flags

Queensland Youth Services acknowledges the Traditional Owners of the regions which we serve.
We pay our respects to Elders past, present and emerging for they hold the memories, the culture and dreams of the Aboriginal and Torres Strait Islander People of this land. 

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(07) 4771 3648

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