Exhibit XIX ADJC Census Report.doc
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- Attached to
- Master Agreement AZ|CTR071424
- Contract number
- CTR071424
- Issued by
- Arizona
About this file
This document is an Exhibit XIX ADJC (Arizona Department of Juvenile Corrections) Census Report template designed for out-of-home residential contractors providing youth residential services. The document is specifically intended for contractors to report bed space availability for Arizona residential programs, with reporting requirements managed by the Community Program Service Office (CPSO).
The report requires contractors to submit bed availability data via email on the 1st and 15th of each month by 10:00 AM, with specific details including contractor name, contact information, level of care, specialty, gender, age range, number of open beds, location, and upcoming discharge status. Contractors are instructed to email the completed report to communityprogramservice@azdjc.gov and can receive training or assistance by contacting CPSO at 602-527-5267. The document was last revised on 6/20/22 and appears to be a standardized tracking mechanism for juvenile residential program capacity across Arizona.
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Text version
EXHIBIT XIX
ADJC Census Report
Out-of-Home residential Contractors, please provide your bed space availability for AZ residential programs. Email the completed report on 1st and 15th of the month by 10:00 AM to the ADJC Community Program Service Office (CPSO) at communityprogramservice@azdjc.gov For training or assistance regarding this report, please contact the CPSO at 602-527-5267.
| Contractor name: |
| Census for the week of |
Contact person phone and email:
Level of Care
(BHIF, BHRF, Group Home or Other)
| Specialty |
| Gender |
| Age |
Range # of open beds Location (City) Upcoming
Discharges
(Y or No)
REV 6/20/22
File details come from the government source that posted it. Updated .