Referral to (Please Tick One Organization)

Referral to (please tick one organization) Organization Contact Address Email Address  YWCA Career and Life Adventure Planning Service Team (HK Phone: 2559 6310 1/F & 2/F Y.W.C.A. [email protected] & Outlying Islands) Fax: 2559 6810 Bonham Residence, (Central and Western District, Wan Chai District, Eastern 38C Bonham Road , District, Southern District, Islands District) Mid-Levels, Hong Kong

 BGCA Career and Life Adventure Planning Service Team Phone: 3692 4470 3/F, Tamson Plaza, [email protected] (Kowloon East) Fax: 3692 4474 161 Wai Yip Street, (Wong Tai Sin District, Kwun Tong District, Sai Kung District) Kwun Tong, Kln  HKCS Career and Life Adventure Planning Service Team Phone: 3580 0110 Rm 119-125, G/F, [email protected] (Kowloon West) Fax: 3427 9588 Lok Yiu House, (Yau Tsim Mong District, Shum Shui Po District, Kowloon City Lai Yiu Estate, District, Kwai Tsing District) Kwai Chung, N.T.  HKCYS Career and Life Adventure Planning Service Team (New Phone: 2420 3522 Office No. 18, 10/F., [email protected] Territories East) Fax: 3020 6224 Shatin Galleria, (North District, Tai Po District, Sha Tin District） 18-24 Shan Mei Street, Fotan, Shatin, N.T.  ELCHK Career and Life Adventure Planning Service Team (New Phone: 3956 4433 Rm 11-12, 18/F, [email protected] Territories West) Fax: 3956 4432 Tuen Mun Central Square, (Tsuen Wan District, Tuen Mun District, Yuen Long District) 22, Hoi Wing Road, Tuen Mun, N.T. Name of person making referral Organization (Position) Contact Phone： Fax： Email： A. Information of Person being Referred Name （Chinese）（English） Gender： ______： Address： Age： ______Contact Phone （Residential） Email Address： No.：（Mobile）

Name of Parent or Guardian： Contact Phone No. of Parent or Guardian：

B. Major Condition of the Person being Referred  Aged 15-21  Other (specify the exact age).

CLAP/CBT/S/RF01E/V02/151008 Copyright © CLAP for Youth @ JC. All rights reserved. Initial assessment of the client’s career planning (Can  more than one item) The client has not yet developed a clear career interest and a future direction (specify the exact age). （Please describe）：

The client does not have any life goals. （Please describe）：

The client has not yet taken actions to actualize his/her plans. （Please describe）：

Current state of the person being referred  Not in Education, Employment or Training （NEET） The person being referred must meet all three Current state: (Can  more than one item) of the following criteria: Unemployed, with motivation to search for work (has sought employment in the last two i) Not enrolled in any formal education months) institutions or courses Unemployed, without motivation to search for work or training (has not sought employment or ii) Not in paid employment for 14 training in the last two months) consecutive days Social withdrawal (duration：） iii) Not enrolled in any formal training Involved in deviant activities Suffering from addiction (e.g. internet addiction, drug addiction） Assuming the role of carer (e.g. for own children or other family members) Confined in institutional care (e.g. in children and juvenile homes or residential drug treatment and rehabilitation centres)  At risk of becoming ‘NEET’ Underemployed： Current state: (Can  more than one item) Employed without a written or verbal engaged in part-time work engaged in low-wage work contract of employment by the same engaged in piecework engaged in unstable work employer for 18 hours or more each changing jobs frequently in the hope of finding more suitable work week for four consecutive weeks in the last two months)

Or At high risk of dropping out or leaving Current state: (Can  more than one item) school early Has not attended schools for 7 consecutive school days With a cumulative of 14 school days of non-attendance within one month

Experiences of transition from school to work (including interests, dreams, life/work skills, training or employment experience)

C. Reasons for Referral

Special service needs or services recommended (Can  more than one item)  Self-understanding and identification of one’s interests  Self-esteem and self-efficacy enhancement and talents

 Exploration of multiple pathways  Work planning skills  Job referral  Strengthening of supportive network  Work exposure programmes/ internship  Motivation enhancement for future planning  Opportunities for interest development  Other (please state)：

D: Referral Statement (*please delete as appropriate) I have obtained *verbal/ written consent from the client or *the verbal/ written consent from the client’s parent or guardian to provide the personal information or documents of the client to your team for application of the services of the CLAP for Youth @ JC. I have been informed that all the information will be kept confidential and will be destroyed within two years after the completion of the Project.

Signature： Date：

E: Referral recommendation ( For internal use only )

CLAP/CBT/S/RF01E/V02/151008 Copyright © CLAP for Youth @ JC. All rights reserved. The referral application is received and approved. ______(name of the social worker) is assigned to contact the referral applicant for the initial assessment before ______(date) which is within 7 working days upon the receipt of the referral application.

Team leader’s comments: ______Signature and name of the Team Leader：（）Date: __

* Referral Receipt Colleagues are requested to fax the Referral Receipt to the referral applicant about the results within 3 days after contact with the referral applicant and completion of the initial assessment.

*Progress Report of Referral Case Colleagues are requested to fill out and fax the Progress Report of Referral Case to the referral applicant within 7 working days after the referral is accepted and has been followed up for three months.

Referral Receipt

To: Name of person making referral: Miss/ Ms. / Mr. ______(Please delete as appropriate) Name of organization: Fax number: Date:

Our team has received your application for services with regard to ______(name of client) on ______(date). Our team’s social worker ______(name of social worker) has also contacted you for the initial assessment of the case on ______(date) (within 7 working days upon the receipt of the referral application). After deliberation, our decision is as follows:

CLAP/CBT/S/RF01E/V02/151008 Copyright © CLAP for Youth @ JC. All rights reserved.  Accept the referral. The district service team will start career and life planning service with the client.  This client has already been accepted as a case (case number: ), the district service team will continue our service with him/ her.  Reject this referral because it does not meet the criteria for service of CLAP for Youth @ JC/ or other reasons: ______

Name of District Service Team: ______Signature and name of the responsible social worker: ______Application date: ______Team Leader’s signature and name ______Approval date: ______

______(Stamp of the District Service Team)

Progress Report of Referral Case To: Name of person making referral: Miss/Ms./Mr.______(Please delete as appropriate) Name of organization: Fax number: Date:

After accepting the referral, the responsible social worker has contacted and followed up with the client ______(name of the client) individually within 3 months. The progress of the follow-up is as follows:

 The client is at the ‘engagement’ phase, we will strive to enhance his/ her motivation so that the client will participate further in our career and life planning services and become a case. Supplementary Information:  The client has been successfully turned into a case in our team and is currently at the stage of *self-understanding/pathway exploration/ career planning and management (*please delete as appropriate) Supplementary Information:  Because the person being referred has insisted not to accept career and life planning services and *has left Hong Kong/ passed away/ been imprisoned or institutionalized over half a year/ other reasons (please state) ______, we

CLAP/CBT/S/RF01E/V02/151008 Copyright © CLAP for Youth @ JC. All rights reserved. cannot reach or maintain stable contact with the client and have to terminate our follow-up. (*Please delete as appropriate) Supplementary Information: Name of District Service Team: ______Signature and name of the concerned social worker: ______Application date: ______Team Leader’s signature and name ______Approval date: ______

______(Stamp of the District Service Team)