INTERSTATE COMPACT ON JUVENILES REPORT OF SENDING STATE UPON PAROLEE OR PROBATIONER BEING SENT TO THE RECEIVING STATE FORM V FORM V TO: DATE: (Receiving State) FROM: (Sending State) (County) (Name of Juvenile) (Date of Birth) RE: The above-named juvenile will depart OR (Race) (Sex) has departed from sending state by (Mode of Transportation) and was instructed to report on in person by telephone OR by letter, within 48 hours of (Date) arrival in the receiving state to: Name: Telephone: ( ) - Address: (Street Address) (City) (State) (Zip) Enclosed please find: (please check applicable items) Parole or probation sanctions Other material as follows: Please acknowledge receipt of this form and send arrival report as soon as possible. Signed: Title: Agency: This is the official ICJ Form V as approved by AJCA in August 2000. No state or other governmental entity party to the Interstate Compact on Juveniles may change, alter or otherwise modify any form that has been approved and adopted for use by the Association of Juvenile Compact Administrators. No other form may be substituted. (See Rule 3-103: Revision/Modification of Forms) ICJ FORM V AJCA Policy and Procedure Manual REVISED JANUARY 2007 3.61 January 2007 American LegalNet, Inc. www.FormsWorkFlow.com INSTRUCTIONS FOR COMPLETING ICJ FORM V PLEASE TYPE OR PRINT LEGIBLY. When to complete this form: This form is to be completed on all transfer of supervision cases. In the case of a juvenile probationer departing to the receiving state prior to the referral materials being sent to the receiving state’s ICJ Office and the case is, therefore, unknown to the receiving state, the juvenile must be instructed to continue reporting to the sending state’s probation officer. The “Out-of-State Travel Permit and Agreement to Return” form is used as a supplement to the Form V. It is the responsibility of the supervising probation officer to ensure that the juvenile receives a copy of the Travel Permit and that s/he is instructed to carry it on his/her person at all times until supervision is picked up in the receiving state. Rule 4-103.1: Transfer of Supervision Procedures of the Interstate Compact on Juveniles Rules and Regulations, as promulgated by the Association of Juvenile Compact Administrators (AJCA), states: Supervision shall not transfer to another state without verbal or written approval from the Interstate Compact on Juveniles office in the receiving state. All verbal approvals shall be followed up with written approval within ten (10) working days after the date the verbal approval was granted. Receiving state: state in which juvenile is residing or will reside. Sending state: state of probation/parole/adjudication; state requesting cooperative supervision services. Juvenile name, etc.: insert juvenile’s name and vital information as indicated. Check the appropriate box: “plans to depart” OR “has departed” sending state; insert mode of transportation; insert date of departure; check one: “in person” OR “by telephone” OR “by letter.” Complete reporting instructions as indicated on receiving state’s report. Check as applicable any enclosures. Signed: The form is to be signed by the sending state’s case worker or parole/probation officer; insert title and agency of signer as requested. AJCA Policy and Procedure Manual 3.62 January 2007 American LegalNet, Inc. www.FormsWorkFlow.com