ENGAGE Enrollment Interview Question Title * 1. Please enter the client's study ID number. Question Title * 2. Please enter the county enrolling the youth. Question Title * 3. Is this youth new to services or have they received any of the following interventions previously? Completely New to Services Received Service Coordination Received Previous Wraparound (not through ENGAGE) Other (please specify) Question Title * 4. Please enter the client's first date of services (If you indicated an intervention prior to ENGAGE Wraparound above, please provide the date of those prior services) Date: Date Question Title * 5. Please enter the date this interview was conducted. Date: Date Question Title * 6. Were you able to conduct the enrollment interview? If no, select why not. Yes No, youth/caregiver refused to participate No, youth/caregiver was not able to be located or withdrew from services 25% of survey complete. Next
