Revised Roster for Contract Facilities

National Survey of Youth in Custody
Facility Youth Roster
Check Roster
Facility Name:
State:
Visit Date:
Age of Consent:

x/xx/2018
xx

Westat Facility ID:
Youth Count:

9999
99

* Was this youth placed in this facility by a state agency or state court?
Note: Federal, tribal, county, or municipal are all non-state entities.

Sequence ID

DOB

Gender

Race / Ethnicity

Admission Date

Most Serious
Offense

(If Other, Specify)

Placed by
State*? Y/N