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REFERRALS FORM
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REFERRERS NAME
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YOUNG PERSONS NAME
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EMAIL
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ETHNICITY
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PHONE NO
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IWI
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AGENCY/SCHOOL
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DATE OF BIRTH
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MM slash DD slash YYYY
POSITION
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CONTACT PREFERENCE
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EMAIL
PHONE
1.Please tell us briefly why you decided to refer this young person to the Tipu Skills For Life Program?
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2.What are you hoping this young person will gain from participating in the Tipu Skills For Life Program?
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3.Tell us briefly what is awesome about this young person?(from the little things to the big)
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4.Have you any concerns for this young person or their safety?
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