Beyond Justice Attendance
Date Attended
Staff Member Email
CLIENT DETAILS
Client's Full Name
Client's Birthdate
Program Engagement
Are they already in Salesforce?
Yes
No
NEW CLIENT CONTACT INFO & DEMOGRAPHICS
Client's First Name
Client's Last Name
Client's Birthdate
Client Phone Number
Phone Number Type
Please select...
Mobile
Work
Home
Other
Can we text you at this phone number?
Yes
No
Client Email Address
Zip Code
What would you like to record for this client?
(check all that apply)
An external referral
An internal referral (to another program at M:STL, PfP or Enterprise)
A resource handout
A case note
A check-in service delivery
An application for rent/utility assistance
CLASS SERVICE DELIVERY
How long was class? (in hours)
Please select...
15 minutes
30 minutes
45 minutes
1 hour
1.5 hours
2 hours
Any additional notes?
Are they getting transportation assistance?
Yes
No
TRANSPORTATION SERVICE
Service
Service ID
Quantity for Single Bus Ticket ($)
Quantity for Weekly Bus Pass ($)
Quantity for Monthly Bus Pass ($)
Quantity for Gas Card (
$ Amount of giftcard
)
Funding Source:
Diversion
P&P
Bulk Code or Last 4 Digits
Notes
CLIENT NOTE
Subject
Type of Interaction
Please select...
In-Person Meeting
Phone Call
Text Message
Case Note
DEMOGRAPHICS
At what point do we want more information about the people coming?
Are you currently employed?
Yes
No
Have you ever been employed?
Yes
No
What type of employment is it?
Part-time
Full-time
Inconsistent
How many LIVE at your house INCLUDING yourself?
Please select...
1 (only you)
2 (you + 1 other person)
3 (you + 2 other people)
4 (you + 3 other people)
5 (you + 4 other people)
6 (you + 5 other people)
7 (you + 6 other people)
8+ (you + 7or more other people)
Race
African American/Black
American Indian
Asian
Hawaiian or Other Pacific Islander
Caucasian/White
Biracial
Multiracial
I do not wish to answer
Other
Other Race
Contact Information