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Challenge for Youth COURSE APPLICATION FORM ‘Time for Change’ 5-DAY Personal Development CourseCourse application form for organisations working with young people Making an application to the 5 Day Personal Development Programme The detailed information we ask for in this form is necessary to help us to provide the best support to each young person who takes part in a course. All information will be treated in confidence. The form is divided into sections: General information General information and contact details about yourself and the young person you are referring. To be completed by the person making the referral Information about any relevant background, about the areas of personal development you wish us to focus on with the young person and about plans for follow-up work on their return home. It also asks for details of any issues that may affect a young person while they are attending a course. Please note that we cannot consider applications from young people who have been convicted of sexual offences, arson or recent serious violent offences. To be completed by the applicant Information about what the young person is hoping to get from the course, about their interests and about any use of alcohol and non-prescribed drugs. This section also includes a checklist and an equal opportunities form. Personal and medical details - to be completed by the applicant with help from the person making the referral Medical details. Because the course is both physically and emotionally demanding we would advise you to give consideration to any current mental health or medical issues, including pregnancy. This section also includes a release and assumption of risk statement. Please do not hesitate to telephone us if you need any further information, or wish to discuss the suitability of a referral When you have completed the form, please return it to: Challenge for Youth Lourene House 112-114 Donegall St Belfast BT1 2GX Tel: 02890 236893 Fax: 02890 324381 E-mail: info@c