| FIELD NAME |
TableName |
FIELD TYPE |
CODED CHOICES |
FORMAT / NOTES |
DESCRIPTIONS |
LENGTH |
| SSN |
Customer |
nvarchar |
NA |
The Social must be 9 digits no more no less |
The following identifying information is necessary to match WIASRD data with the DEI administrative data elements. |
9 |
| FIrstName |
Customer |
nvarchar |
NA |
The first name must be less that 64 characters. |
|
64 |
| LastName |
Customer |
nvarchar |
NA |
The last name must be less that 64 characters. |
|
64 |
| Birthdate |
Customer |
Date |
mm/dd/yyyy; |
mm/dd/yyyy; Record the date of birth |
|
10 |
| PhoneNumber |
Phone |
nvarchar |
NA |
the phone number must be 10 digits representing the area code and
the phone number no foreign numbers excepted |
|
12 |
| Consent to Provide Information |
Consent |
Boolean |
1 = male;0=Female |
|
|
1 |
| EmailAddress |
Email |
nvarchar |
NA |
Email address must be less than 64 charaters |
|
64 |
| Gender |
Customer |
Boolean |
1 = male;0=Female |
1 = male;0=Female |
|
1 |
| DEIR5 |
Round5Participation |
Boolean |
1=Yes;0=No; |
Is the customer a DEI Round 5 participant? |
Enter Yes if this participant is enrolled in DEI. Not all customers are DEI participants. See FAQ Bulletin 8 for information DEI participants versus individuals that self-disclose a disability but are not DEI participants. |
1 |
| IF NO, skip remainder of DEI Questions |
|
|
|
|
|
|
| DEIR5CP |
Round5Participation |
Boolean |
1=Yes;0=No; |
Did the participant receive DEI Round 5 career pathway services (DEIR5CP)? |
Will (has) this individual been enrolled in a career pathways program? |
1 |
| Which service delivery strategies did/will this participant receive? |
|
|
|
|
|
| DEIR6IRT |
Round6Participation |
Boolean |
1=Yes;0=No; |
a. Integrated Resource Teams (DEIR6IRT) |
Will (does) this individual have an IRT as part of her/his enrollment in DEI? |
1 |
| DEIR5ILP |
Round6Participation |
Boolean |
1=Yes;0=No; |
b. Individual Learning Plans (DEIR6ILP) |
Will (does) this individual have an ILP as part of her/his enrollment in DEI? |
1 |
| DEIR6BB |
Round6Participation |
Boolean |
1=Yes;0=No; |
c. Integrated Resources/Blending and Braiding (DEIR6BB) |
Has the DRC or other AJC staff, secured blended or braided resources to support this individual's package of services? |
1 |
| DEIR6WS |
Round6Participation |
Boolean |
1=Yes;0=No; |
d. Case Management/Wraparound Services (DEIR6WS) |
Will (has) this individual received wraparound/intensive case management services? |
1 |
| DEIR6WB |
Round6Participation |
Boolean |
1=Yes;0=No; |
c. Work-Based Experience (DEIR6WB) |
Will (has) this individual received a work-based experience, such as an internship, apprenticeship, job shadowing etc? |
1 |
| DEIR6OJT |
Round6Participation |
Boolean |
1=Yes;0=No; |
d. On the Job Training |
Will (has) this individual received on the job training from an employer for which she/he was hired? |
|
| Which disabilities did this participant self-disclose? |
|
|
|
|
|
| Disability1 |
Disability |
Boolean |
1=Yes;0=No; |
Attention-Deficit/Hyperactivity Disorders; |
See DEI Evaluation Bulletin 9 |
1 |
| Disability2 |
Disability |
Boolean |
1=Yes;0=No; |
Blindness or Low Vision;*No child care |
|
1 |
| Disability3 |
Disability |
Boolean |
1=Yes;0=No; |
Brain Injuries; |
|
1 |
| Disability4 |
Disability |
Boolean |
1=Yes;0=No; |
Deaf/Hard-of-Hearing; |
|
1 |
| Disability5 |
Disability |
Boolean |
1=Yes;0=No; |
Learning Disabilities; |
|
1 |
| Disability6 |
Disability |
Boolean |
1=Yes;0=No; |
Medical Disabilities (e.g. muscular sclerosis) |
|
1 |
| Disability7 |
Disability |
Boolean |
1=Yes;0=No; |
Physical Disabilities |
|
1 |
| Disability8 |
Disability |
Boolean |
1=Yes;0=No; |
Psychiatric Disabilities |
|
1 |
| Disability9 |
Disability |
Boolean |
1=Yes;0=No; |
Speech and Language Disabilities |
|
1 |
| Disability10 |
Disability |
Boolean |
1=Yes;0=No; |
Developmental and Intellectual Disabilities |
|
1 |
| Disability_DA1 |
DailyActivity |
Boolean |
1=Yes;0=No; |
Do you need any special reminders to attend to your daily activities or chores? YES/NO |
|
1 |
| Disability_DA2 |
DailyActivity |
Boolean |
1=Yes;0=No; |
Do you take care of anyone else such as a wife/husband, children, grandchildren, parents, friend, other? YES/NO |
|
1 |
| Does your disability affect your ability to: |
|
|
|
Activities of Daily Living: The following questions (Activities of Daily Living) help to determine the functional challenges of DEI participants. DRCs or other AJC staff should ask the participant to respond to each question. It is recommended that you get to know the DEI partiipant prior to entering this information as doing so will improve the accuracy of the information provided. This information is used to match comparison group and treatment group individuals. |
|
| Disability_DA3 |
DailyActivity |
Boolean |
1=Yes;0=No; |
Dress? YES/NO |
|
1 |
| Disability_DA4 |
DailyActivity |
Boolean |
1=Yes;0=No; |
Go shopping? YES/NO |
|
1 |
| Disability_DA5 |
DailyActivity |
Boolean |
1=Yes;0=No; |
Prepare your own meals? YES/NO |
|
1 |
| Disability_DA6 |
DailyActivity |
Boolean |
1=Yes;0=No; |
Drive a care? YES/NO |
|
1 |
| Disability_DA7 |
DailyActivity |
Boolean |
1=Yes;0=No; |
Find a job and return to work |
|
1 |