Enrollment Call Checklist Form
Complete this Enrollment Call Checklist Form to ensure all essential steps are covered during your enrollment call. Please fill out each field accurately to document the conversation and next actions.
Full Name of Participant
*
First Name
Last Name
Date of Call
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Caller's Name
*
First Name
Last Name
Contact Method
*
Phone
Video Call
Other
Enrollment Eligibility Confirmed
*
Yes
No
Required Documents Received
*
Yes
No
Pending
Enrollment Status
*
Please Select
Enrolled
Pending
Not Eligible
Withdrawn
Next Steps Explained to Participant
*
Yes
No
Follow-Up Date (if applicable)
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Additional Notes
Submit Checklist
Should be Empty: