Physical Yes Know Yes Yes Know Doesn’t Doesn’t Disability _____/_____/_____ No No Refused No Refused Yes No Notes: Client know doesn’t Client Refused Do you have a case worker with the Illinois Department of Child and Family Services (DCFS)? Yes No Not Applicable    Have you ever been involved in the child welfare system? Yes No Not Applicable    If Yes, did you age out of the foster care system? Yes No Not Applicable    This means you were in foster care when you became of age (18-21), you were not adopted and you were not reunified with family. Instead you were recognized as an adult and freed from the foster care system.
Physical Disability Yes No Client doesn’t know Client Refused _____/_____/_____ Yes No Yes No Doesn’t Know Refused Yes No Doesn’t Know Refused Notes: Do you have a case worker with the Illinois Department of Child and Family Services (DCFS)?  Yes  No  Not Applicable Have you ever been involved in the child welfare system?  Yes  No  Not Applicable If Yes, did you age out of the foster care system?  Yes  No  Not Applicable This means you were in foster care when you became of age (18-21), you were not adopted and you were not reunified with family. Instead you were recognized as an adult and freed from the foster care system.
SubCook_Initial_Intake_Assessment_20181001.docx