FOR INTERNAL USE ONLY
COMPLETED STEPS: Phone Screening ⬜ Required Docs ⬜ Intake ⬜ ID ⬜
ORIENTATION FEE: $150 (Both) ⬜ $75 (Individual) ⬜ $100 (Private) ⬜ $30 (TP) ⬜
COMMENTS: _______________________________________________________________________
RELEASE OF INFORMATION: FCS ⬜ Attorney ⬜ Therapist ⬜ Evaluator ⬜ Other: ____________
RECEIVED DOCUMENTS: FCS Reports ⬜ Current Court Orders ⬜ Current RO ⬜
Proof of Income ⬜ Child Support ⬜
COMMENTS: ________________________________________________________________________
ATTORNEY CONTACT (if applicable): VP ⬜ RP ⬜ NONE ⬜
AUTHORIZED TP: ____________________________
SIGNED 2HK AGREEMENT: ⬜