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sportz cfielz izvYlpmYNt pRogrfm rYPrl / arjLI Pfrm - sPf 3<br />
jy mOjUd hox qF aissmYNt dy pypr quhfzy bwcy dI ivkfs nfl sMbMiDq shfieqf leI hwkdfrI df PYslf krn leI cfhIdy hn[ ikrpf krky ies<br />
rYPrl Pfrm nfl pypr lfAux dI sihmqI idAu[<br />
sihmqI:<br />
mYN ies rYPrl Pfrm, aqy Auprly syvfvF dyx vfilaF qoN imly pyprF nUM, ijnHF `qy mYN dsKq kIqy hn, ienHF nUM jfrI krn leI sihmqI idMdf/idMdI hF:<br />
ircmMz sportz cfielz izvYlpmYNt poRgrfm hF nhIN (ikrpf krky Coty dsKq kro)<br />
cfielz kyar poRgrfm, smyq _________________________________________ hF nhIN (ikrpf krky Coty dsKq kro)<br />
(cfielz kyar poRgrfmF df (dy) nF)<br />
mfpy/gfrzIan dy dsKq ________________________________________________<br />
qrIk _________________________________<br />
rYPrl dy vsIly bfry jfxkfrI:<br />
rYPr krn vfly ivakqI df nF aqy/jF rYPrl ivc pirvfr dI mdd krn vfly ivakqI df nF: ____________________________________<br />
rYPr krn vflI sMsQf (jy aijhf pirvfr ny nhIN kIqf): _________________________________________________________________<br />
Pon nMbr: _______________________________<br />
mYN ies rYPrl vsIly qoN afpxy bwcy nfl sMbMiDq ilKqI aqy jLbfnI jfxkfrI ley jfx dI afigaf idMdf/idMdI hF (ijwQy ieh pirvfr nhIN hY)<br />
ircmMz sportz cfielz izvYlpmYNt poRgrfm hF nhIN (ikrpf krky Coty dsKq kro)<br />
mfpy/gfrzIan dy dsKq<br />
qrIk<br />
rYPrl Pfrm dy gvfh dy dsKq<br />
qrIk<br />
FOR INTERNAL USE ONLY<br />
Date Referral Received: ______________________ Referral Received By: ____________________________<br />
Designated SCD Consultant /Intake Consultant: _________________________________________<br />
Date SCD Support Services Initiated: _______________________________<br />
Notes:__________________________________________________________________________________________________________________<br />
________________________________________________________________________________________________________________________<br />
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________________________________________________________________________________________________________________________<br />
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Referral/Application Form July 2005 [<strong>Punjabi</strong>]
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