yAsp Referral yAsp E-Referral Client Details:Clients Name*Preferred Pronouns:Address*Date of Birth*Contact Number*Email*Emergency Contact:Name*Contact Number(s)*Email Address*Relationship to the client*Please answer the following questions:Does the young person identify as Aboriginal or Torres Strait Islander?*YesNoDoes the Young Person agree to this Referral? (yAsp is a voluntary program)*YesNoIs the parent/guardian aware of this referral?*YesNoIs it appropriate to contact the parent/guardian?*YesNoDetails if no:*Does the young person have stable accomodation? *YesNoAre they currently attending school/training?*YesNoDetails*Have they been a previous yAsp client?*YesNoReferral InformationPlease indicate the reason for referral*What goals would the young person like to acheive while they are in the program?*Please list any other agencies/workers the young person is involved withPlease answer the following questions in relation to risk.Are there any risks associated with suicide or self harm?*YesNoPlease provide further details*Are there any other risks we need to be aware of?*YesNoFurther Details*Please provide details about the person making this referral:If you are referring yourself, please tick this box. Self-ReferralYour Name*Your Phone*Your Email Address:*Organisation/Agency: *SubmitReset