Reader auto-assigned: James Thompson
Your reader was matched automatically during pre-course. (Clients without a match show "Pending assignment.")
Program-aware form: Fields and steps below render dynamically for your program type (DV-BIP 52wk) — one of 55 course variants. Coursework navigation stays locked until pre-course intake is complete (milestone gating: Registered → Pre-course → Active).
Client Contact Information
Please provide accurate contact details. This information is used for program communications.
Submitted May 3, 2026 • Read-only (intake complete)
Demographics
Demographic information used for program reporting and SPSS data.
Encrypted (AES-256)
Substance & Lethality Assessments
Risk assessments and substance use evaluations.
Completed May 3, 2026 · 12 questions · Read-only
1. In the past 12 months, have you used alcohol?
Yes — socially, 1–2 drinks per week
2. Have you used cannabis, prescribed or otherwise?
No
3. Have you used other illicit substances?
No
4. Has substance use ever interfered with work, family, or court obligations?
No
5. Has anyone close to you expressed concern about your use?
No
Completed May 3, 2026 · 8 questions · Read-only
1. Have you ever sought treatment for substance use?
No
2. Have you used substances within 24 hours of a court appearance?
No
3. Do you currently take prescribed medications that affect mood or judgment?
No
4. On a 1–10 scale, how would you rate your control over substance use?
9 — Strong control
About your course length
Where a lethality/risk screening exists, it is completed by your referring agency before your referral, and it is what sets the number of weeks in your course. ✓ Confirmed — Stephanie (Round 2) Streets2Schools does not administer or score that screening, and its result is not shown in your portal.
⚑ PENDING — how course length is set when no rating is supplied to S2S
Completed May 3, 2026 · Lifetime history · Read-only
Prior domestic-violence-related arrests
1 — 2022
Prior CPO violations
0
Use-of-weapon history
No
Prior BIP enrollments
0
Completed May 3, 2026 · 6 questions · Read-only
Are you currently in any recovery program?
No
Have you previously attended AA, NA, or similar?
No
Would you like a referral to community resources?
No
Sponsor or accountability contact?
N/A
Pre-Course Knowledge & Acknowledgments
Required before coursework begins.
TEK Pre-Course Assessment
Topic & Engagement Knowledge baseline — Completed May 3, 2026
Mandated Reporter Notice — Acknowledged
I understand staff are mandated reporters and that disclosures of harm to self or others, child/elder abuse, may be reported as required by law. Acknowledged May 3, 2026.
DVCBS — Domestic Violence Cognitive Behavioral Survey (68 questions)
The same 68 questions are answered at enrollment and again at completion so the program can measure your growth. This survey is separate from your orientation and from any internal assessments.
Pre-course (baseline) — 68 questions
Completed May 3, 2026 · 68 of 68 answered
Post-course — 68 questions
Administered at program completion (graduation)
Content Acceptance Steps
Each section is acknowledged separately (not a single checkbox).
Agreements & Consent
Program agreements, waivers, and consent forms requiring your electronic signature.
The set below renders for your program type (DV-BIP 52wk). Other programs (DAP, PP) show a different agreement list.
An agreement was updated and needs your signature again
The Agreement with Program changed from v2.0 to v3.1. Your prior signature is no longer current — please review the updated terms and re-sign to stay enrolled.
Agreement with Program
Re-sign requiredUpdated to v3.1 · Your v2.0 signature (May 3, 2026) is no longer current
Group Confidentiality Agreement
Signed May 3, 2026
Release of Information
Signed May 3, 2026
Waiver of Confidentiality
Signed May 3, 2026
Webinar Recording Consent
Signed May 3, 2026
Team Commitment Agreement
Signed May 3, 2026
Document Uploads
Upload required identification and court documents. You need to provide a photo ID, proof of income, and your court documents. Accepted file types are JPG, PNG, or PDF, up to 5 megabytes each. Tap a box below to upload a file or drag and drop it.
Photo ID
JPG, PNG, or PDF up to 5MB
Click to upload or drag and drop
Proof of Income
The only evidence the Financial Assessment takes — proof of expenses is asked for only if you appeal a denial.
Click to upload or drag and drop
Court Documents
Court order, referral letter, or sentencing docs
Click to upload or drag and drop
Program Payment (Income)
Streets2Schools offers a sliding scale based on your ability to pay. This step is optional — if you skip it, you simply pay the standard program rates. It never affects your enrollment.
Financial Assessment (sliding scale / ability to pay)
Your Information (including spouse) · Monthly Income · Monthly Expenses · what you owe and what you own · the last 4 questions · signature under penalty of perjury. Staff evaluate the completed form and assign your weekly fee — the form does not set it for you.
⚠ The form needs to be FULLY completed (including the last 4 questions) or it will be returned and your evaluation process will start over.
Evidence: proof of income only (since 10/30/2024). You are not asked for proof of expenses unless you appeal — but still fill the Monthly Expenses Box in, because an appeal is evaluated against the expenses listed on the form.
Prefer not to share income details? No problem — continue at the standard program rates (standard prices as of 9/30/2024: cost of sessions $40-50/week; signup fee $100 before start of class; prices may vary by jurisdiction). You can still request an assessment later if your circumstances change.
The weekly-fee-by-income table is now known verbatim and is shown inside the form. Still owed by S2S: the form's own question text for each of the five sections; who gives final approval and on what rule (the SOP covers the procedure "excluding final approval"); how the expenses listed on the form change the outcome on appeal; and how per-jurisdiction price variance is applied ("prices vary within and across jurisdictions depending on referring agency"). The determined fee shown at the "Determined" stage and on payments.html depends on those.
After you submit, S2S reviews your Financial Assessment — it may take up to 1-2 weeks. Your result is given to you after your enrollment is finalized, and a weekly fee reduction does not change your enrollment fee ⚑ PENDING — which fee "enrollment fee" names ($100 signup fee? the intake fee?), and whether a reduction touches the absence / rescheduling / exit-interview fees. If your monthly income — on its own or combined — is over $2,500 you do not qualify for a reduction at this time; you can appeal, and then you will need to send proof of the expenses you listed on the form. The full form lives at income-intake.html.
Webinar & Schedule Setup
Select your preferred webinar schedule and set up A/V requirements.