My Way Youth Mentoring Project – Refer a Mentee

If you prefer to fill this out by hand and send in, please download the PDF HERE, otherwise fill out the automatic form below
Prevent disadvantaged female youth from entering the criminal justice system.


Referral DateClient(Young Person/Mentee):


Date of Birth


Cultural Background
Program Eligibility (Client must answer yes to all):
The Mentee is at risk of custodial sentence?

The Mentee is voluntarily seeking support?

The Mentee is currently living in the Sydney Metropolitan / Western Suburbs area?

The Mentee is aged 14-25?

Mentee’s current living situation:
What is the Mentee’s current living situation?

Is the Mentee regularly attending school?

Client Information:

(In your view why is this Mentee at risk of being affected by the Criminal Justice System?):
In contact with the CJS

Received a caution

Been arrested

How would this Mentee benefit from a mentor?

Referrer’s Details:

Referrer’s First Name

Referrer’s Last Name

Referrer’s Organisation:

Referrer’s Position

Referrer’s Phone

Referrer’s Email

Is this Mentee aware that the referral is being made?