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 : RBWO
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>
optional note for labels: <span style="font-family:helvetica;font-size:75%;font-weight:normal;font-style: italic;color:red"> (optional)</span>
no po box note<span style="font-family:helvetica;font-size:75%;font-weight:normal;font-style: italic;color:red">(No PO Box)</span>
vtab =
debug:
sites: (text of integer)
vendorsection
vensecgeneral
RBWO/Residential Provider Application

Please enter data on all tabs before submitting your application

ProviderGeneralLicensingAdmissionsPrimary 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

Physical Address
Street (No PO Box)

Street2 (optional)

City
State
Zip

Program Website


Owner Contact Information :

Last
First
Phone
Email
Executive Director Contact Information:
Last
First
Phone
Email
Fax (optional)

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

RBWO/Residential Provider Application Checklist
FY26 DHS RBWO Minimum Standards
DJJ RBWO 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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