Exhibit XIX ADJC Census Report.doc
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- Attached to
- Master Agreement AZ|CTR071406
- Contract number
- CTR071406
- 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 document is specifically intended for contractors to report bed space availability to the ADJC Community Program Service Office (CPSO), with instructions to email the completed report twice monthly by 10:00 AM.
The report requires contractors to provide detailed information including their name, contact details, level of care (such as BHIF, BHRF, Group Home), specialty, gender, age range, number of open beds, location, and indication of upcoming discharges. Contractors can obtain training or assistance by contacting the CPSO at 602-527-5267, with the report template last revised on 6/20/22. The primary purpose appears to be tracking and managing residential placement capacity for juvenile justice programs 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 .