Exhibit XVIII ADJC Monthly Attendance Report.doc
DOC document 104 KB Posted
- Attached to
- Master Agreement AZ|CTR071408
- Contract number
- CTR071408
- Issued by
- Arizona
About this file
This document is an Arizona Department of Juvenile Corrections (ADJC) Monthly Attendance Report form designed for out-of-home contractors providing juvenile services. The form is specifically used by contractors to report monthly details about ADJC juveniles in their care, with mandatory submission to the Community Program Service Office (CPSO) by the 3rd business day of the following month.
The report requires contractors to document comprehensive information about each juvenile, including their ADJC identification number, level of care/program type (such as BHIF, BHRF, Group Home, Shelter Care), placement date, days absent, reason for absence, discharge date, and discharge reason. Contractors must include juveniles placed or funded by various agencies including DCS, RBHA, Interstate, Private Pay, or other sources. The form provides a structured template for accountability and tracking of juveniles across different care settings, with contact information available at 602-527-5267 for training or assistance in completing the report.
View the file
Other files
Show all 37
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
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 .