Exhibit XVIII ADJC Monthly Attendance Report.doc
DOC document 104 KB Posted
- Attached to
- Master Agreement AZ|CTR071466
- Contract number
- CTR071466
- 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 providing services to juvenile offenders. The report is to be completed monthly and submitted electronically to the Community Program Service Office (CPSO) by the 3rd business day of the following month. Contractors are required to document details for all ADJC juveniles in their care, including those placed or funded by other agencies such as DCS, RBHA, Interstate, Private Pay, or other entities.
The report template requires contractors to track specific information for each juvenile, including their ADJC identification number, level of care/program type (BHIF, BHRF, Group Home, Shelter Care, or Other), placement date, days absent, reason for absence, discharge date, and reason for discharge. The document provides contact information for training or assistance at 602-527-5267 and an email address for report submission (communityprogramservice@azdjc.gov). The template is designed to ensure accountability and comprehensive tracking of juvenile placements and movements within the juvenile corrections system.
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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 .