Client Intake (add new client to caseload)
Client ID
*
Client Status
Active (contact in past 90 days)
Inactive (no contact in between 90 days - 6 months)
Closed (no contact for >6 months)
Name of Supporting SNC
*
Case Opened Date
*
Intake Location
*
Calgary
Edmonton
Other (specify)
Referral Source
Make a choice
211
Community Agency
Police/ALERT
Other SNC
Self-Referral
Other (specify)
No items available
Client Demographics
Client Date of Birth
Client Gender
Make a choice
Female
Male
Non-Binary
Two-Spirit
Transgender
Other (specify)
No items available
Client Education
Make a choice
Less than high school
High school diploma or GED
Some post-secondary
Completed post-secondary
Unknown
No items available
Client Preferred / Primary Language
Make a choice
English
French
Other (specify)
No items available
Client Home City/Town
Client Citizenship/Immigration Status
Make a choice
Canadian Citizen/Permanent Resident
Temporary Resident (e.g., international student, foreign worker)
Non-Status Foreign National
Unknown
No items available
Client Ethnicity (select all that apply)
Black
East Asian
Indigenous
Latin American
Middle Eastern/Arab
South Asian
Southeast Asian
White/Caucasian
Other (specify)
Unknown (specify reason)
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