Get Attention Intake Coordinator - Atlanta Mission - Atlantamission

Completing the Attention Intake Coordinator form is an essential step toward finding support and resources through Atlanta Mission. This guide provides a clear and concise overview of how to fill out the online application, ensuring that you understand each section and the information required.

Follow the steps to successfully complete the intake application.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by providing your personal information in Section 1. Fill in your name, date of birth, age, and social security number. Next, enter your current address, including street, city, state, and zip code. Include your phone number and specify if messages can be left.
3. In Section 2, indicate your marital status and any child support obligations. If applicable, list details about your children, such as name, age or birth date, and relation.
4. Move to Section 3 to provide your income history. Check all sources of income you receive and state the total monthly amount. Include your occupation and the date of your last employment.
5. In Section 4, address your alcohol and drug abuse history by checking relevant substances and noting your last usage date. Detail your treatment history by indicating how many facilities you have attended and completed.
6. Section 5 asks about your mental health. Indicate any diagnosed conditions, previous hospitalizations, prescribed medications, and any history of suicide attempts.
7. Provide your legal history in Section 6. State any arrests, criminal convictions, and details about probation or parole if applicable. List any pending charges.
8. In Section 7, share your education history, including the highest grade completed, whether you graduated or obtained a G.E.D., and any colleges or vocational schools attended.
9. Fill out Section 8 with your medical history. Note the date of your last physical, current physician details, and any medical conditions you may have.
10. Review the acknowledgment in Section 9, sign at the bottom of the form, and print your name and the date. Ensure all sections have been accurately completed.
11. Once you have finished, save the changes, download the completed form, and share or print it as necessary.

Complete your intake application online today to take the first step towards support and recovery.