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Youth Music Mentors Programme Gloucestershire. Referral form What is being offered? One to one music mentoring linked to music for 20 young people aged 11 to 25 who are in “challenging circumstances” (see below for full criteria). Each mentoring relationship should last for a minimum of 10 sessions and will aim to increase music skills, knowledge of opportunities, personal development, resilience, and support young people in making positive life choices.

What is music mentoring? “Music mentoring is using music as a common ground and shared interest to develop a relationship with a mentee in order to support them in making significant changes in knowledge, behaviour and thinking” “Through this process the Music Mentor coaches the individual musically in order to achieve on a musical as well as a social level”

Criteria: Ages 11 to 25 living in Gloucestershire. Music is special part of their lives and they are seriously interested in making music in some way. “In Challenging Circumstances” – in the first instance we are only taking referrals of young people who fall into one or more of these categories: excluded from school, at serious risk of exclusion, young offenders, or at risk of offending, NEET, or looked after. All referrals will be assesses against these criteria. We will not necessarily be able to give places to all referred young people.

For further information contact XXXXXXXXX

Forest of Dean Makers - Charity no. 1106979, Company no. 5195945 Registered address: SoundSpace, Heywood Campus, Cinderford, GL14 2AF Music-based Mentoring: Individual Action Plan template From ‘Music-based mentoring: a learning resource for practising mentoring’ on Network.youthmusic.org.uk


Youth Music Mentors Programme Gloucestershire.

Referral Form Referring person name: Agency: Contact details:

Young person being referred – name: Date of Birth: Contact details (where appropriate for direct contact): Referral category – please tick all that apply: Has been excluded from school in last 2 yrs  At serious risk of being excluded from school  At risk of offending, or repeat offending  Not in employment, education or training (aged 16 to 18)  Looked after or care leaver  Undertaking for people being referred I understand that this will involve: A commitment to attend 10 mentoring sessions. Engaging with music making activities both in the sessions and at other times. I hope to get the following things out of the mentoring ……..

I give my permission for this referral to be made (young person) Signed.

Date

Venues for sessions will be arranged to best meet the needs of the referred young person, the mentor and the needs of safeguarding and safe working. Referrals can be sent as scans (or we can get the signature later) Email to: xxxxxx By post to: xxxxxxxx Referrals can also be made by telephone xxxxxxxx (leave a message with times that you can be reached. Forest of Dean Makers - Charity no. 1106979, Company no. 5195945 Registered address: SoundSpace, Heywood Campus, Cinderford, GL14 2AF Music-based Mentoring: Individual Action Plan template From ‘Music-based mentoring: a learning resource for practising mentoring’ on Network.youthmusic.org.uk


Sample referral form