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
This document is an Invitation to Negotiate (ITN) issued by the Florida Department of Juvenile Justice (DJJ) 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 DJJ is seeking proposals 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, as well as provide statewide support services, data collection and reporting, management, and enforcement of the required services. The CINS/FINS residential services are for youth between 10 and 18 years old, while the non-residential services are for youth between 6 and 18 years old. The DJJ also seeks to procure a lead agency to subcontract and provide management and administrative oversight of a statewide network of community-based respite care service providers for youth between 10 and 18 years old who have been charged with domestic violence, are on probation, or are in need of respite services.
The DJJ is seeking proposals that will deliver all service components inclusive of CINS/FINS, Statewide Respite Care Services, and evidence-based or promising practices delinquency prevention programming. A properly prepared Youth Discharge form and invoice must be submitted to the DJJ's Contract Manager within 15 business days following the end of the month for which services were rendered. If services are not rendered within a 30-day period, the youth will be released/discharged from the program.
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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.
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