Case Mgr Enrollment

To Be Completed By Case Managers Only

Client's First & Last Name *

Client's Best Phone Number *

Client's Best eMail Address

Workbook/Course Assigned *

AEP

Alcohol Related Offenses

Anger Management

Co-Dependency

Cognitive Awareness

Driver Responsibility

MJ 101 / Simple Possession

Offender Corrections

Offender Responsibility

Shoplifting

Please describe the arrangement made with client *

Client acknowledges & accepts arrangement *

Case Manager's Name *

Case Manager's Comments

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