Intake Completion Form

Intake Completion Form

Please Complete This Form After Completing a New Member Intake
Name of the New Member*
Member Phone Number*
Please enter a valid phone number.
Member email address*
example@example.com
Name of Manager Filling out This Form

First NameLast Name
House Name

Bryant GardensJayPenroseSullyTuftsTwin LakesWinonaZuni
Apartment Number
Date and Time of Intake*

MonthDayYear
Date
Hour MinutesAM/PM Option
Did the member pass a quick test?*

YesNo
Was a safety inspection performed of the new member and their belongings for any prohibited items?*

YesNo
Was a comprehensive tour conducted?*

Highlighted Key AreasEmergency ExitsCommunal SpacesIntroduced to Housemates
Did you confirmed the new member has reviewed/signed paperwork and paid?*

Elevate New Member ContractReliatrax PaperworkPayment
Was the Member Handbook Reviewed?*

House RulesElevation Plan PhasesChoresImportance of Fostering a Strong Culture and Community Building at the HouseGood Neighbor Policy
Does the new member understand when mandatory groups are scheduled?*

House MeetingsUA Testing
Was all the essential logistical information received by the new member?*

WiFi InformationIssued a Lockbox and Set Code (Stress Importance for Medication Storage)Provided Front Door Key CodeProvided WhatsApp InformationAdded to Group Chats with Introduction in Main Elevate Chat
Was the new member shown the Member Portal?*

YesNo
Was the new member connected with Peer Coaches?*

YesNo
If the Client is on Scholarship. Did You Stress The Importance of The New Member Attending 10 Hours of Coaching / Week if On Scholarship?

YesNoNot On Scholarship
Was the Intake successful?*

YesNo
Additional Notes For Management Regarding New Member
File Upload

Upload signed member completion form
Cancelof
Was Photo of Hard Copy Uploaded?

YesNo
Was reminder of BPS given?

YesNo
Client Signature

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Should be Empty: