Assessment at Entry Form
Description: Welcome to the
Assessment & IDP page.
This page displays the Assessment
at Entry form. Here users have the capability to complete the Assessment at Entry form. The Assessment at Entry form MUST
be completed within 14 days of the participant's enrollment in the YouthBuild
system.
Functions: This page contains
the following functions:
Add the Assessment at Entry
Complete the following to Add the Assessment at Entry form to the participant's
case:
Note:
To view the Eligibility Rules
for the participants, click the Eligibility
Rule link located on the top right hand side of the Assessment
at Entry form.
Mental
Toughness:
Basic
Skills Deficient:
Note: Note:
Any participant who has a high school diploma must be basic skills deficient
to be eligible for this program. For the purposes of the DOL YouthBuild
program, a youth who is defined as basic skills deficient must test at
or below the High Intermediate Basic Education EFL (Educational Functioning
Level), which is equivalent to below the 9th grade, in either literacy
or numeracy. Please confirm these test scores before responding to this
question.
Date
of Enrollment:
In the Date
of Enrollment text box, enter the date the participant enrolled
in the YouthBuild program. Users can also use the  (Calendar) icon to select the date of
enrollment. Once this date has been entered and the Assessment at Entry
form has been saved, this date CANNOT be updated. (Required
field)
Co-Enrolled in WIA
Selective Service
Note:
This field is required and MUST be
marked 'YES' IF
the participant is a Male AND
between the ages of 18
- 25.
Employment: This
section MUST be completed within 14 days of Date of Enrollment.
If this section is not completed, the participant will NOT count towards the QPR.
Select one of the Employment
Status at Enrollment radio buttons. Using the Occupation
at Enrollment drop-down list, select the participant's occupation
at the time of enrollment. In the Occupation
Title text box, enter the participant's title. (Optional) In the Hours
Worked at Enrollment text box, enter the number of hours per week
the participant worked at the time of enrollment. (Per
week) In the Hourly
Wage at Enrollment text box, enter the hourly wage the participant
made at the time of enrollment. (00.00) In the Start
Date for Job at Enrollment text box, enter the start date for the
job the participant was working at the time of enrollment. Users can also
use the (Calendar)
icon to select the start date for the job at enrollment.
Additional
Information:
Select one of the Citizen
Status (US Citizen?) radio buttons. Select one of the Authorized
to Work radio buttons. Select one of the Voter
Registration radio buttons. Select one of the Drivers
License radio buttons.
Family,
Education and Other:
Using the Housing
Status at Enrollment drop-down list, select the participants housing
status at the time of enrollment. Select one of the Alcohol
Abuse/Drug Use at Enrollment radio buttons. Select one of the Marital
Status radio buttons. In the Children
text box, enter the number of children the participant currently has.
In the Children
Living with Participant text box, enter the number of children
that are currently living with the participant. In the Other
Dependents Living with Participant text box, enter the number of
other dependents currently living with the participant. Using the Highest
School Grade Completed drop-down list, select the highest school
grade completed by the participant. (Required
field) Select one of the Limited
English Proficient radio buttons. Select one of the Health
Issues radio buttons.
Second
Additional Information:
Note:
To select multiple services, depress the 'Ctrl'
key and select applicable service(s) with the mouse.
Note:
This field has a 4000 character limit.
Note:
To select multiple benefits, depress the 'Ctrl'
key and select applicable benefits with the mouse.
In the If
other, please specify text box, enter the name of the other medical
benefit applicable to the participant. Select one of the Mental
Health Treatment radio buttons. In the Child
Support Obligation at Enrollment text box, enter the number of
children the participant was supporting at the time of enrollment. In the Child
Support Obligation at Enrollment text box, enter the amount of
money the participant was providing to the children he/she was supporting
at the time of enrollment. In the Public
Assistance Prior to enrollment field, select the applicable public
assistance provided to the participant prior to enrollment.
Note:
To select multiple services, depress the 'Ctrl'
key and select applicable service(s) with the mouse.
Note:
This field has a 4000 character limit.
In the Amount
of Public Assistance Prior to enrollment $ text box, enter the
dollar amount of Public Assistance the participant has been given prior
to enrollment. In the Duration
of Public Assistance Prior to enrollment text box, enter the duration
(in months) of Public Assistance
the participant has been given prior to enrollment In the Types
of Medical Benefits Prior to enrollment field, select the types
of medical benefits applicable to the participant prior to enrollment.
Note:
To select multiple benefits, depress the 'Ctrl'
key and select applicable benefits with the mouse.
Warning
Message
Successfully
Saved Message
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Printable Version
Located next at the top of the Assessment
at Entry form is a  (Printer)
icon. When selected, the printer icon will open the information on the
Assessment at Entry form in a
printable window. Click the  (Printer)
icon located on the top of the page to print a copy of the Assessment
at Entry form. If the Assessment
at Entry form is blank, the Printable Version will be blank as
well. The Assessment at Entry form must
be saved before the information will appear in the Printable Version.
Note: Users MUST
have Adobe Acrobat Reader in
order to view the Assessment at Entry
form in the printable window.
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(
(Ok) button to confirm
the enrollment date is correct. This will display the