10848_ITN_Exhibit 3_Youth_Discharge_Form.pdf

PDF 95 KB Posted

Attached to
CINS/FINS & Statewide Respite Care Services
Solicitation number
ITN-09961
Issued by
Leon County, Florida

About this file

The document is an Exhibit 3 Sample Youth Discharge Form related to the Florida Department of Juvenile Justice (DJJ) Solicitation #10848 for Children In Need of Services/Families In Need of Services (CINS/FINS), Statewide Respite Care Services, and evidence-based or promising practices delinquency programming. The ITN seeks proposals throughout Florida from community, faith-based, not-for-profit organizations, LLCs, and/or divisions of local government to design, create, develop, implement, manage, and ensure coordination of local delivery of residential and non-residential statewide services for CINS/FINS youth and families, provide statewide support services, data collection and reporting, management, and enforcement. The CINS/FINS residential services are for youth between 10-18 years old, and the non-residential services are for youth between 6-18 years old. The Statewide Respite Care Services are for youth between 10-18 years old who have been charged with domestic violence, are on probation, or have been issued a pre-delinquency citation.

The document outlines that if services are not rendered within a 30-day period, the youth will be released/discharged from the program. A properly prepared Youth Discharge form and invoice must be submitted to the Department's Contract Manager within 15 business days following the end of the month for which services were rendered.

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File Type Posted
10848_ITN_Exhibit 3_Youth_Discharge_Form.pdf PDF
ITN_10848.pdf PDF
ITN_10848_Attachment Q.pdf PDF
10848_ITN_Exhibit 3_Youth_Discharge_Form.pdf PDF
ITN_10848_Attachment J.xlsx XLSX spreadsheet
ITN_10848_Attachment T.docx DOCX document
ITN_10848_Attachment L.docx DOCX document
ITN_10848_Attachment R.docx DOCX document
ITN_10848_Attachment T.docx DOCX document
10848_ITN_Exhibit 1_Invoice.pdf PDF
10848_ITN_Exhibit 3_Youth_Discharge_Form.pdf PDF
ITN_10848.pdf PDF
ITN_10848_Attachment N.docx DOCX document
ITN_10848_Attachment Q.pdf PDF
ITN_10848_Attachment T.docx DOCX document
ITN_10848_Attachment J.xlsx XLSX spreadsheet
ITN_10848_Attachment Q.pdf PDF
ITN_10848_Informational_Notice_1.pdf PDF
ITN_10848_Informational_Notice_3.pdf PDF
10848_ITN_Exhibit 1_Invoice.pdf PDF
ITN_10848_Addendum_1.pdf PDF
ITN_10848_Attachment J.xlsx XLSX spreadsheet
ITN_10848_Attachment L.docx DOCX document
ITN_10848_Attachment R.docx DOCX document
ITN_10848_Informational_Notice_4.pdf PDF
10848_ITN_Exhibit 1_Invoice.pdf PDF
ITN_10848_Attachment R.docx DOCX document
ITN_10848_Attachment T.docx DOCX document
ITN_10848_Attachment L.docx DOCX document
10848_ITN_Exhibit 1_Invoice.pdf PDF
10848_ITN_Exhibit 4_Start-Up_Implementation.docx DOCX document
ITN_10848.pdf PDF
ITN_10848_Addendum_1.pdf PDF
ITN_10848_Attachment Q.pdf PDF
ITN_10848_Informational_Notice_1.pdf PDF
ITN_10848_Attachment L.docx DOCX document
10848_ITN_Exhibit 1_Invoice.pdf PDF
10848_ITN_Exhibit 3_Youth_Discharge_Form.pdf PDF
10848_ITN_Exhibit 4_Start-Up_Implementation.docx DOCX document
ITN_10848.pdf PDF
ITN_10848_Attachment T.docx DOCX document
ITN_10848_Informational_Notice_2.pdf PDF
ITN_10848_Attachment N.docx DOCX document
ITN_10848_Informational_Notice_1.pdf PDF
ITN_10848_Notice_of_Final_Agency_Decision.pdf PDF
ITN_10848_Informational_Notice_2.pdf PDF
10848_ITN_Exhibit 4_Start-Up_Implementation.docx DOCX document
ITN_10848_Attachment J.xlsx XLSX spreadsheet
ITN_10848_Attachment N.docx DOCX document
ITN_10848.pdf PDF
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Text version

ITN #10848

EXHIBIT 3

SAMPLE YOUTH DISCHARGE FORM

Youth’s Name (First initial, Last name) _____________________________________________

JJIS Number ___________________________________________________________________

Admission Date_________________________________________________________________

Discharge Date_________________________________________________________________

Program Instructor’s Signature____________________________________________________

*If services are not rendered in a 30 day period, the youth will be released/discharged from the program.

A Youth Discharge form with a properly prepared invoice shall be submitted directly to the Department’s Contract Manager within 15 business days following the end of the month for which services were rendered.

File details come from the government source that posted it. Updated .