Exhibit XVIII ADJC Monthly Attendance Report.doc
DOC document 104 KB Posted
- Attached to
- Master Agreement AZ|CTR071445
- Contract number
- CTR071445
- Issued by
- Arizona
About this file
This document is an official monthly attendance reporting template for the Arizona Department of Juvenile Corrections (ADJC) used by out-of-home contractors. The form is designed for contractors to document juveniles in their care, including those placed or funded by various agencies such as the Department of Child Services (DCS), Regional Behavioral Health Authorities (RBHA), Interstate placements, Private Pay, or other sources. The report must be submitted electronically to the Community Program Service Office (CPSO) by the 3rd business day of the following month.
The reporting template requires detailed tracking of juveniles, 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. The document provides a structured format for contractors to maintain accountability and provide comprehensive information about juveniles in their care, with contact information available for training or assistance at 602-527-5267. The template was last revised on 6/20/22 and is intended to ensure accurate reporting and monitoring of juvenile placements across different care settings.
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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 .