Contents
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Completing the Parent Information
Complete the details for the client as described below on the New Referral Client Information (page RR0004).
Intake Date*
Enter the date on which the intake is taking place.
Last*, First* and Middle Names and Suffix
Enter the name of the parent in the appropriate name fields. If you have selected a previously entered party from the Search Results page, this name will be carried forward from that selection.
Date of Birth*
Enter the date of birth using the following format MM/DD/YYYY.
Gender
Select Female or Male by using the radio button next to the field (
).
SSN (Social Security Number)
Enter the Social Security Number for the applicant.
Home Address
Enter the first line of the Mailing Address in this field.
Address Line 2
Enter the second line of the Mailing Address in this field.
City
Type the name of the city in this field.
Town
Select the name of the town by using the down arrow (
) next to the field.
State
The State has been defaulted to Vermont; however if another selection is needed, select the name of the state by using the down arrow () next to the field.
Zip Code
Enter the zip code in this field using the format #####-####.
Mailing Address
If the mailing address is different than the residence address, complete the field for the first line of the mailing address.
Address Line 2
If the mailing address is different than the residence address, complete the field for the second line of the Mailing Address.
City
If the mailing address is different than the residence address, complete the field for the name of the city.
State
If the mailing address is different than the residence address, complete the field for state. The State has been defaulted to Vermont; however if another selection is needed, select the name of the state by using the down arrow () next to the field.
Zip Code
If the mailing address is different than the residence address, complete the field for the zip code using the format #####-####.
Daytime Phone Number*
Enter the daytime telephone number for contact in this field using the format ###-###-####.
E-mail Address
Enter the complete e-mail address for the applicant.
Employer Name
Enter the name of the client's employer in this field.
Income Category
Select the value for the income by using the down arrow () next to the field.
$15,000 or Less
$15,001 to $24,999
$25,000 to $34,999
$35,000 to $44,999
$45,000 to $54,999
$55,000 or More
Family Size
Select the value for the size of the family by using the down arrow () next to the field.
3 or Fewer
4
5
6 or More
Service Need
Check each of the needs that apply by clicking in the box next to the value:
Both Employment and Training
Developmental Growth
Employment
Family Support
Job Search
Protective Service
School/College
Self Employed
Health Need/Disability Child
Health Need/Disability Parent
Training
To uncheck a selected need, just click in the box again to remove the selection.
More:
Contact Information (Referral)
Submitting Client Intake Information