Exhibit XIX ADJC Census Report.doc
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- Attached to
- Master Agreement AZ|CTR071409
- Contract number
- CTR071409
- 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 in Arizona. The report is to be submitted bimonthly (on the 1st and 15th of each month) to the Community Program Service Office (CPSO) via email, with contact information provided for training and assistance.
The census report requires contractors to detail their bed space availability, including specific information such as level of care (BHIF, BHRF, Group Home, or Other), specialty, gender, age range, number of open beds, location by city, and indication of upcoming discharges. Contractors are expected to comprehensively track and report their residential program capacity, enabling the ADJC to monitor and manage youth placement resources across the state's juvenile corrections system.
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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 .