GAIN-SS License Inquiry

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Thank you for your interest in acquiring a license for the GAIN (Global Appraisal of Individual Needs) Short Screener. Funding for licenses is available to up to 50 schools through June of 2023.

Электронная почта *

1. Your last name *

2. Your first name *

3. Your role within your school or district *

Pupil Services/Student Services Director

Building Administrator

School Counselor

School Psychologist

School Social Worker

School Nurse

District Staff

Coach or Intervention Specialist

Mental Health Navigator

Другое:

4. Name of school *

5. Name of district *

6. When do you plan to begin using the GAIN-SS with students? *

7. In order to secure future funding and understand the needs of schools, please help us by sharing how you will be using the GAIN-SS in your setting (e.g., Alcohol, Tobacco and Other Drug Use screening, Mental Health Screening, Violence screening, etc.) *

Next Steps

Thank you for submitting your interest in the GAIN-SS license.
The WISH Center will communicate your request to Chestnut Health Systems, who will follow up with enrollment and license setup information.
Please email Tracy Herlitzke, WISH Center Director, therlitzke@cesa4.org if you do not receive a response within two weeks of submitting this form.

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Конфиденциальность Условия

Форма создана в домене Cooperative Education Service Agency #4. Сообщение о нарушении

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