Client Information |
Child First Name* |
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Child Last Name* |
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Child Birth Date* |
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Child Cell Phone* |
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Child Home Email |
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Child Race and Ethnicity* |
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Gender* |
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Sexual Orientation* |
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Language* |
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Household Income* |
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For data purposes only |
Total Number of Household Members* |
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Intake Information |
Client Placement Status* |
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Case Management County |
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FAC Location |
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COMBAT questions |
Questions for Combat funding survey |
COMBAT Queries* |
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