Kia Tupu, Kia Hua, Kia Puāwai
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Agency referral to Youth Service West

Our services

Please select the service that would best fit your referral

NEET service

Not in education, employment or training. Free mentoring and coaching for at-risk young people in West Auckland (aged 16-17 years). We offer support into training, education, employment, gaining a drivers' licence, and driving lessons. We work together to explore opportunities and to improve overall wellbeing.

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YP/YPP

Young person and young parent payment. Free support for young people (aged 16–17 years) and young parents (aged 16–19 years) eligible for financial assistance and offering support into training, education and improving overall wellbeing.

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Ka Awatea

Free programme designed to assist young people (aged 15–25 years) who are leaving Oranga Tamariki care and transitioning to adulthood.

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Young Person/Parent/
Guardian/Significant Other

Young person's name

Date of birth (DD/MM/YYYY)

Age

Full address

Current activity

Please select a current activity

Service enquiry

If your answer to current activity was other, please specify (optional)

Support person's name

Phone number (home)

Relationship to young person

Phone number (work/other)

Are family members aware of this referral?

Yes

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Referrer details

Name

Organisation

Phone number (home)

Phone number (work/other)

Relationship to young person

Email address

Reason for referral (you can select more than one option)

Including Court ordered, FGC recommendation, personal motivation. Please outline briefly what your expectation is of how we support your referral.

Reason for referral

Poor Attendance / Truancy

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Seeing School Counselor

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Family / Home Situation

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Youth Justice

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Mental Health

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Health Concerns

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Social Issues / Isolation

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Young Parent / Partner

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Drugs & Alcohol

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Literacy / Numeracy

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Safety / Risk Issues

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Housing

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Employment

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Financial Support (YP)

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Oranga Tamariki involvement?

Yes

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Details (optional)

Other agencies involved (optional)

Any other information

Does the Young Person consent to this referral?

Yes

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Date (DD/MM/YYYY)

Do you consent to the information above being used by Kia Puāwai?

Yes, I confirm that all the personal information stated above is accurate and I consent and authorize Kia Puāwai to process my data.

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Thank you! We've received your referral

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Agency Referral to Youth Service West

Our services

Please select the service that would best fit your referral

NEET Service

NEET service

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YP / YPP

YP/YPP

Radio

Ka Awatea

Free programme designed to assist young people (aged 15–25 years) who are leaving Oranga Tamariki care and transitioning to adulthood.

Radio

Young Person/Parent/
Guardian/Significant Other

Young Person's Name

Date of Birth (DD/MM/YYYY)

Age

Full Address

Current Activity

Please select a current activity

Service enquiry

If Your Answer to Current Activity Was Other, Please Specify (optional)

Support Person Name

Phone Number (Home)

Relationship to Young Person

Phone Number (Work/Other)

Are family members aware of this referral?

Yes

Radio

Referrer Details

Name

Organisation

Phone Number (Home)

Phone Number (Work/Other)

Relationship to Young Person

Email Address

Reason for referral

Including Court ordered, FGC recommendation, Personal Motivation. Please outline briefly what your expectation is of how we support your referral

Reason for Referral

Poor Attendance / Truancy

Checkbox

Seeing School Counselor

Checkbox

Family / Home Situation

Checkbox

Youth Justice

Checkbox

Mental Health

Checkbox

Health Concerns

Checkbox

Social Issues / Isolation

Checkbox

Young Parent / Partner

Checkbox

Drugs & Alcohol

Checkbox

Literacy / Numeracy

Checkbox

Safety / Risk Issues

Checkbox

Housing

Checkbox

Employment

Checkbox

Financial Support (YP)

Checkbox

Oranga Tamariki Involvement

Yes

Radio

Details (Optional)

Other Agencies Involved (Optional)

Any other information

Does the Young Person consent to this referral?

Yes

Radio

Date (DD/MM/YYYY)

Do you consent to the information above being used by Kia Puāwai?

Yes, I confirm that all the personal information stated above is accurate and I consent and authorize Kia Puāwai to process my data.

Radio

Thank you! Your submission has been received!

Oops! Something went wrong while submitting the form.

Kia Puāwai is a registered charity under the name Kia Puāwai, registration number CC23952

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0800 375 210
42 Vestey Drive, Mt Wellington, Auckland 1060

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Agency referral to Youth Service West

Our services

Young Person/Parent/Guardian/Significant Other

Referrer details

Reason for referral (you can select more than one option)

Agency Referral to Youth Service West

Our services

Young Person/Parent/Guardian/Significant Other

Referrer Details

Reason for referral

Young Person/Parent/
Guardian/Significant Other

Young Person/Parent/
Guardian/Significant Other