Case Mgr Enrollment
To Be Completed By Case Managers Only
York County Diversion Programs
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 *
Yes
No
Case Manager's Name *
Case Manager's Comments
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