Exhibit XVIII ADJC Monthly Attendance Report.doc
DOC document 104 KB Posted
- Attached to
- Master Agreement AZ|CTR071431
- Contract number
- CTR071431
- Issued by
- Arizona
About this file
The document is an Arizona Department of Juvenile Corrections (ADJC) Monthly Attendance Report template designed for out-of-home contractors. It is specifically used to track and report on juveniles in care, with a requirement to submit the report electronically to the Community Program Service Office (CPSO) by the 3rd business day of the following month. The form is to be completed by contractors serving ADJC juveniles, including those placed or funded by other agencies such as DCS, RBHA, Interstate, Private Pay, or other entities.
The report template requires detailed tracking of each juvenile, including their ADJC identification number, level of care/program type (such as BHIF, BHRF, Group Home, Shelter Care), placement date, days and reasons for absences, discharge date, and discharge reason. Contractors must provide comprehensive information about each juvenile in their care, with contact information for the person completing the report. The document appears to be a standardized accountability and tracking mechanism for juvenile care services, last revised on 6/20/22, with contact support available at 602-527-5267 for training or assistance.
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Text version
EXHIBIT XVIII
ADJC Monthly Attendance Report
Out-of-Home Contractors, please complete this report on a monthly basis to confirm accuracy in the accountability of ADJC juveniles in your care. This report shall be emailed to the ADJC Community Program Service Office (CPSO) at communityprogramservice@azdjc.gov by no later than the 3rd business day of the following month. For training or assistance regarding this report, please contact the CPSO at 602-527-5267.
| Contractor Name: |
| Month/Year services provided: |
Contract number _ ___________ Please list all ADJC juveniles in your care including those placed and/or funded by another Agency i. e. DCS, RBHA, Interstate, Private Pay or Other (Type the first and last name;
Include one juvenile per line)
ADJC
K #
Level of Care/Program
BHIF, BHRF, Group Home, Shelter Care or Other
Date placed in the program
Days absent during the month
| Reason for the absence |
| Discharge Date |
| Reason for the discharge |
1.
2.
3.
4.
5.
6.
7.
| Report completed by |
| Date |
| Phone |
| REV 6/20/22 |
| page 1 |
File details come from the government source that posted it. Updated .