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Client Population Analysis Center
Intensive Home Treatment (SFP) Registration and Evaluation
Gender of Adult Completing This Form
Gender of "Target" Child
What is your primary race? (race of most of your biological ancestors?)
Hispanic or Latino
What is the language you use most often at home?
What is your current parenting status?
Two Parents at Home
Joint or Shared Custody
Child(ren) in Foster Care
Children with Relatives
What is your relationship to the "target" child living with you?
Aunt or Uncle
Older Sister or Brother
Close Non-relative (Mentor/Advocate)
How long has the "target" child lived with you? (0 if child not living with you)
Where are you living now?
Farm or Ranch
Resort or Tourist Town