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EXHIBIT D <br />Juvenile Court Evidence Based Expansion <br />MONTHLY REIMBURSEMENT REQUEST FORM SFY24-25 <br />Attach completed Form(s) to an Invoice Voucher Form (A-19) when submitting requests for payment <br />to JR. Note: Complete a separate MONTHLY REIMBURSEMENT REQUEST FORM for each type of <br />intervention (FFT, MST, COS and EET). <br />COUNTY <br />MONTH/YEAR <br />INTERVENTION PROGRAM <br />(FFT, MST, ETC.) <br />COSTS THIS MONTH <br />Administrative (not to exceed 15%) <br />$ <br />TOTAL COST <br />$ <br />Department of Children, Youth & Families <br />2017CF County Program Agreement 6-24-20 Page 18 <br />