Exhibit_J_-_Service_Closure_Report.docx
DOCX document 19 KB Posted
- Attached to
- Master Agreement AZ|CTR056116
- Contract number
- CTR056116
- Issued by
- Arizona
About this file
The document is a Pre-Employment Transition Services Service Closure Report form, which appears to be a standard administrative template used for documenting the conclusion of vocational rehabilitation services for an individual client. While specific state or agency details are not fully completed in this example, the form is designed to track service outcomes for a vocational rehabilitation contractor working with clients seeking employment support.
The form provides a structured mechanism for reporting service closure, with sections detailing successful and unsuccessful service terminations. Potential closure scenarios include client satisfaction, relocation, health issues, incarceration, loss of contact, changed circumstances, or determinations by the Rehabilitation Services Administration (RSA). The document allows for documenting client outcomes, skills demonstrated, and reasons for service discontinuation, with designated spaces for contractor and counselor signatures to formalize the service closure process.
View the file
Other files
Show all 20
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
Pre-Employment Transition Services Service Closure Report
Section I: Basic Information Client's Name:
Contractor Name/Contractor Representative:
| Contract Number: |
| Authorization Number: |
VR Counselor:
Section II: Successful Service Closure Information Date of Service Closure:
Client outcomes achieved and skills demonstrated:
Section III: Unsuccessful Service Closure Information |_| Client was not satisfied with the service provision and requested another Contractor |_| Client moved out of service area |_| Client was unable to complete services due to health issues |_| Client was incarcerated |_| Contractor lost contact with the client |_| Client circumstances have changed and they no longer wish to pursue employment services |_| Contractor can no longer serve client due to organization or business changes |_| Contractor no longer willing to work with client |_| RSA determined services were no longer appropriate |_| Other reason for closure (specify):
Section IV: Signatures:
| Contractor Representative: |
| Date: |
VR 2017-6-13 Page 1 of 1
File details come from the government source that posted it. Updated .