Effective Dates (paydates)
Effective Dates (1st and 16th)
Deadline Dates
Georgia Department of Juvenile Justice
Office of Residential and Community Based Services
A resource provided by The Administrative Applications Team of OTIS
Having trouble with this site? Contact ORCBS:
Monday-Friday 8am-5pm at 678-350-4809
Racquel Watson, Director
DJJ Web Site



Current Position or Title
Job Title:
On Behalf Of
Person to Contact:
Tel / Contact #:
Location Category:
Title:
Email:
   
Location:
Alternate Contact Information
Prefix:
Name (Last, First):
,
Tel/Contact#:
Email:
Your Home Location Information
Final Office Name:
Primary Phone #:
Address:
City, State Zip
City
Subject Location
Final Office Name:
Primary Phone #:
Address:
City, State Zip
City
Location Contact Info
Location director
Other
(override email address)
Location Asst directorNone specified
Other
(override email address)

LocationApproverNames:

LocationApproverEmails:

Org -Division/Office   (Important: Controls Division approvers for this request)
Division:
Office:
DivisionApproverNames :

DivisionApproverEmails:
ACName:
ACEmail:

Region
Primary Region
Click the button to the right
to show Regions. Select III for Central
District
Primary District:
Click the button to the right
to show Districts. Select 3B for Central
Requirements
Requirement Details:

Request Summary
Summary of important elements of the request:
Approvers
Approving Name:
Name of Supervisor, Director, or Division Head
Approver Email Address
Approver Telephone
Detailed Notes
Provide Detailed notes or any other information below:
Narrative
Provide a narrative below:
Inbound Email Information
Email Below is from inbound email:
From:
To:
Subject:
Body of incoming email

Request Origin
Origin/Source:
Request Type Selection

Community Based Services
Clear and Reload New
Clear and Reload Current (Direct)
About This Request Type
Quick Note To Requester
Email Control
Requester(s)?
Additional To:
Additional CC:


Other CC:
venDeptvendor
venAppType : WRAP
all fields required note html :<br><span style="font-family:helvetica;font-size:75%;font-weight:normal;font-style: italic;color:red">* all fields are required (unless specifically noted as optional)</span><br>
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vtab =
debug:
sites: (text of integer)
vendorsection
vensecgeneral
Vendor WRAP Application

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ProviderGeneralAdmissionsPrimary Site
Provider Information..

all fields are required (unless specifically noted as optional)

Provider Name

Corporate Address (Street or PO Box)

Street2 (optional)

City
State
Zip
Owner Contact Information :

Last
First
Phone
Email

Executive Director Contact Information:
Last
First
Phone
Email

NOTE: Please review the document links below to ensure you submit a complete application. Links will open in a new tab/window.

Requirements for WRAP
WRAP Standards
PREA Policy checklist
DJJ PREA Policy (For Reference Only)

Please download, complete and attach to this application the W-9 Form and the Vendor Management Form.
Links provided below.
Instructions for filling out VMF Form
Vendor Management form
W-9 form







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