STEAMS SERVICES
Group Services
Individual Services
Community Outreach Form
Justice Form
Victimization Form
Back
Next
SMOKETOWN T.E.A.M.S GROUP SERVICES
Staff Name:
*
First Name
Last Name
Staff Email:
*
You will receive a copy of submission.
Participant Name:
First Name
Last Name
Date:
*
-
Month
-
Day
Year
Date
COHORT YEAR
*
Please Select
2024
2025
2026
GROUP SERVICE:
*
Please Select
Intervention Services
Prevention Services
Supportive Services
Trauma-Informed Services
Group Service Partcipants:
Specific Service:
*
Afterschool Support/ Group
Boys Group
Girls Group
Community Service Project
Field Trip
Financial Literacy Education
Homework Help
Lunch Bunch
Transportation
Other Support Groups
Social/ Emotional Learning Group
Submit
Back
Next
SMOKETOWN T.E.A.M.S INDIVIDUAL SERVICES
Staff Name:
*
First Name
Last Name
Staff Email:
*
You will receive a copy of submission.
PARTICIPANT NAME
*
First Name
Last Name
Date:
*
-
Month
-
Day
Year
Date
COHORT YEAR
*
Please Select
2024
2025
2026
GRADING PERIOD:
Please Select
Current Grading Period
Previous Grading Period
Previous Grade
Please Select
A
B
C
D
F
U
Current Grade
Please Select
A
B
C
D
F
U
GROUP SERVICE:
*
Please Select
Intervention Services
Prevention Services
Supportive Services
Trauma-Informed Services
Specific Service:
*
Collaboration with Faculty/ Administration
Community Service
Financial Literacy
High School Prep
Link with Academic Supports
Mental Health Therapy Support
Mentorship
Other Support Services
Outside Resources/ Suppors
Social Emotional Learning Support
Transportation
YouthBuild Tutoring Support
Case Notes:
Case Notes
Submit
Back
Next
Community Outreach Form
Staff Name:
*
First Name
Last Name
Staff Email
*
You will receive a copy of submission.
COHORT YEAR
*
Please Select
2024
2025
2026
Name of Event:
*
Date of Event:
*
-
Month
-
Day
Year
Date
Location of Event:
*
Brief Description of Event:
*
Number of Attendees:
*
Number of Attendees on Caseload:
*
Submit
Back
Next
Justice Form
Staff Name:
*
First Name
Last Name
Staff Email
*
You will receive a copy of submission.
COHORT YEAR
*
Please Select
2024
2025
2026
Name of Participant:
*
First Name
Last Name
Date of Incident:
*
-
Month
-
Day
Year
Date
Type of Offense
*
Please Select
Criminal
Status
Violent
Violation of Court Order/ Condition
Outcome of Incident
*
Please Select
Adjudicated
Detained
Incarcerated
Submit
Back
Next
Victimization Form
Staff Name:
*
First Name
Last Name
Staff Email:
*
You will receive a copy of submission.
COHORT YEAR
*
Please Select
2024
2025
2026
Name of Participant:
*
First Name
Last Name
Age of Participant:
*
Date of Incident:
*
-
Month
-
Day
Year
Date
Type of Incident:
*
Please Select
Neglect/ Emotional Maltreatment
Non-Violent Crime
Physical Abuse
Sexual Abuse
Violent
Submit
Should be Empty: