Darebin Learner Driver Referral form

Name of person enquiring/

referring
Job title (if applicable)
Name of organisation (if
applicable)
Contact number/s

Ivy Nguyen

Name of young person

Gender
Age
Date of birth
Contact number/s

Ivy Nguyen
Female
19
08/01/1996
0402843010

Email address/es
Address

ivy.nguyen.contact@gmail.com
14 Barwon Avenue, Reservoir
3073, VIC

Family/ living situation (in relation

to having access to a suitable
adult to teach you/ them to drive
& access to a suitable car)

Father works as a taxi driver and

therefore works long shifts that
make him unavailable at suitable
times for driving lessons and
supervision. Mother has a history
of anxiety and does not feel
capable/comfortable to teach and
supervise. Family owns only 1 car
which is not always available if
my father needs to park it
elsewhere for work or if my
mother drives it to her
hairdressing classes (approx. 3
full days a week).

0402843010

Other relevant information (eg;

English as second language,
newly arrived, mental health
issues)
Has Learners Permit & Log Book?

Yes

Office use only

Name of Darebin L2P Worker/
Volunteer
Date of first contact
Method of first contact (eg phone,
email)
Date of follow up
Outcome (left message, spoke to,
etc)

Eligibility
Meets age eligibility criteria
Lives in Darebin
Lacks a suitable adult in their life to teach them to drive
Lacks a suitable car to learn to drive in
Has Learners Permit & Log Book

(Yes/ No)

Action/ next step

Done

Explain waiting time is approximately ten months

Send Darebin L2P brochure
Last updated 27/11/ 14