10848_ITN_Exhibit 3_Youth_Discharge_Form.pdf
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- 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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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 .