Exhibit XVIII ADJC Monthly Attendance Report.doc
DOC document 104 KB Posted
- Attached to
- Master Agreement AZ|CTR071449
- Contract number
- CTR071449
- Issued by
- Arizona
About this file
This document is an official monthly attendance reporting form for the Arizona Department of Juvenile Corrections (ADJC), specifically designed for out-of-home contractors providing juvenile care services. The form is to be completed monthly by contractors and submitted to the ADJC Community Program Service Office (CPSO) via email by the 3rd business day of the following month, with contact information provided for training or assistance.
The report requires detailed tracking of ADJC juveniles in care, including their unique identifiers (K #), 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. The form accommodates multiple juveniles and can include those placed or funded by other agencies like DCS, RBHA, Interstate, Private Pay, or other sources. The document appears to be a standardized accountability mechanism for monitoring juvenile placement and care across different contracted facilities and programs.
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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 .