Please complete all sections to the best of your knowledge

Referring Agency
Agency telephone number *
Agency telephone number
Young person
Contact Number *
Contact Number
Date of birth
Date of birth
Why do you think this young person would be suitable for this programme? Please tick all that apply
Referral Guidelines
ACN is a Youth Inclusion,Action Program aimed at risk youth and high intensive need support groups, whilst increasing the social inclusion of the target group. Research has indicated that young people ‘at risk’ will have been arrested or cautioned, and/or have low or no qualifications, poor attendance at school and have been continually unemployed since leaving school. Therefore, to ensure that we are reaching our target group, the young people referred should meet at least three of the criteria below, from more than one category. Please tick as many criteria as apply. Thank you for your co-operation.
The age group
Participation in offending behaviour
School/College Factors
Social Issues
Substance Abuse