SPAN Referral Form

SPAN works with young people who live in Hamilton and are between the ages 16 – 18 years who are not currently in full-time employment, education, training or receiving an unemployment benefit.

Learn more about the SPAN programme here »

SPAN Referral

Young Person's Name(Required)

The name of the young person you think would be a good fit for this programme.

First Last

Their date of birth(Required)

Their town/city(Required)

Their ethnicity(Required)

e.g. Māori, Pasifika, NZ European

Do they fit the above criteria?(Required)

(Young person, aged 16-18, who is not currently in employment, education or training or receiving an unemployment benefit.)

Yes

They meet some of the criteria, but not all

Unsure

Have they been in contact with the Police or Oranga Tamariki?(Required)

Yes

Unsure

Please provide brief details

Caregiver's name(Required)

First Last

Caregiver's phone number(Required)

Referrers name(Required)

First Last

Referrers phone number(Required)

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SPAN Referral Form

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