Exhibit XVIII ADJC Monthly Attendance Report.doc
DOC document 104 KB Posted
- Attached to
- Master Agreement AZ|CTR071405
- Contract number
- CTR071405
- Issued by
- Arizona
About this file
This document is an Arizona Department of Juvenile Corrections (ADJC) Monthly Attendance Report template designed for out-of-home contractors providing juvenile care services. The form is specifically created for contractors to document and report monthly details about ADJC juveniles in their care, with submission required by the 3rd business day of the following month to the Community Program Service Office (CPSO) via email.
The reporting template requires contractors to comprehensively track juvenile placement information, including individual juvenile identification (K number), level of care/program type (such as BHIF, BHRF, Group Home, Shelter Care), placement date, days absent, absence reasons, discharge date, and discharge reasons. The document is intended to ensure accountability and accurate tracking of juveniles across various care settings, including those placed or funded by different agencies like DCS, RBHA, Interstate, Private Pay, or other entities. Contractors must complete the report with detailed, line-item information about each juvenile in their program.
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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 .