Make a Referral





Service Detail



Young Person or Parent’s (Mentee) Details


















Referral Details












Status with Referral Agency




















Mentee Contact Details














Residing with Details










Household details




Offending Behaviour & Threats






























Substance Use














Medical History


Learning Difficulties














Health and Safety






Reason for Referral


Any Additional Information








European Structural Fund (ESF) Criteria - Labour Market








European Structural Fund (ESF) Criteria - Disadvantage






















Restorative Justice Referrals Only


Model of Restorative Justice the young person is being referred for

















Oberstown Temporary Release Only






































Data Protection
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