Form 1: Admission Agreement
Admission Agreement
This contract is made and entered into on ____________________________[Date] between
____________________________ [Name of Client] and Inner Circle: Find Your Way Home.
Inner Circle: Find Your Way Home agrees to provide the following services:
1. Provide the client named above with a transitional housing site that has been certified to care
for his or her needs in accordance with applicable laws and regulations. Housing will include all
furnishings and household items needed to live independently. Inner Circle supplies all basic
furnishing (living, dining, and bedroom), bed linens, towels, kitchenwares, toiletries, and
cleaning supplies. Inner Circle is responsible for paying rent, utilities, gas, electric, wireless
Internet and landline phone bills. Inner Circle does NOT provide a cell phone or pay for cell
phone service.
2. Assign a Caseworker to the client upon acceptance into the program who will provide case
management, guidance, and support to the individual. Caseworkers meet weekly with clients.
3. Assist the client in setting and attaining his or her education and career goals by developing a
Needs and Services Plan, tracking progress, creating Improvement Plans, and connecting clients
to community resources.
4. Provide various educational seminars monthly regarding financial literacy, budgeting,
pregnancy prevention, achieving educational goals, professional development, and study skills.
A monthly calendar of upcoming seminars will be provided to the client by his or her
Caseworker during a weekly meeting.
5. Work together with the placing county agency to encourage the maintenance of permanent
connections with the client’s family members, and other significant adults, as indicated in the
transition plan, and/or young adult and family teams whenever possible.
6. Will use constructive alternative methods of harm reduction; not use corporal punishment;
Inner Circle will never withhold monetary allowances, threaten in a degrading manner or use
humiliating punishment.
7. Respect and keep confidential information given about this client.
8. Written progress reports on the transition plan progress will be provided on a quarterly basis
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Form 1: Admission Agreement
(every three months) or more frequently by mutual agreement.
9. Give the client a 30-Day Written Notice of intent to discharge or move. The placing county
agency will be informed of any intended move of this client between certified sites prior to the
move. Inner Circle has the authority to move a client in the case of imminent risk to the young
adult or others in the household. Inner Circle will notify the placing county agency within 24
hours of such move.
10. Provide a stipend (allowance) of $250 twice monthly for a total of $500 per month to be used
for individual expenses, food, budgeting, clothing and savings. Stipends will be distributed on
the 2nd and 4th weekly meeting of each month by the Caseworker during a weekly meeting.
Clients who have a checking or savings account established will receive their stipends in the
form of a check from Inner Circle. Clients who have not established a checking or savings
account will receive their stipends in the form of cash. Regardless of how stipends are
distributed, all clients are required to sign a register acknowledging receipt of the funds.
11. Provide monthly Regional Transit passes or gas cards (not to exceed $100 monthly) and
assist in using public transportation. These will be distributed during weekly meetings with the
Caseworker as needed.
As a client in this program, I agree to the following:
1.
I agree to respect the rules outlined in the household agreements made during house
meetings.
2.
I understand that there is a strict NO ALCOHOL, MARIJUANA or ILLEGAL DRUG
policy and that possession, use, or sale of these substances is prohibited, including at Inner
Circle: Find Your Way Home sponsored activities and events. Illegal drugs, alcohol, and.or
marijuana are NEVER permitted on Inner Circle properties or at any Inner Circle events.
3.
I understand that I am not allowed to have any weapons or simulated weapons (legal and
illegal) in the household or at any meeting or activity that involves program clients or staff.
4.
I will not steal or have any stolen property in my possession.
5.
I will not use physical violence, make threats of violence or harass neighbors of the
program site, program employees, household members, or other participants.
6.
I will not destroy any property.
7.
I understand that I may decorate my bedroom to my own taste as long as there is no gangrelated, drug-related, obscene, or offensive subject matter on display and agree that a Caseworker
may determine the appropriateness of any questionable subject matter.
8.
I understand that I will be held financially liable for any damages that I am responsible
for at the property where I will reside. I will attend an orientation with the apartment complex’s
property manager to gain a full understanding of my role as a tenant.
9.
No visitors may be in the apartment unless the client is present. Anyone who is not an
Inner Circle staff member or enrolled program client is considered to be an unauthorized visitor
and is not permitted to live in the unit under any circumstances. Occupancy by unauthorized
visitors is considered a breach of the house rules.
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Form 1: Admission Agreement
10.
With Caseworker pre-approval, clients may have one overnight guest for one night in a
single week and no more than four total nights within a one month period.
11.
Any guest staying on the property after 10:00 pm is considered an overnight guest and
must be pre-approved by the Case Worker.
12.
Clients may have visitors during the daytime hours of 8:00 am-10:00 pm.
13.
I understand that I will be held responsible for the behavior of my visitors and agree to
follow house rules regarding visiting and quiet hours which are between 10:00pm-8:00am. I will
obtain permission prior to having any overnight guests and will not harbor runaways or allow
any unauthorized people to reside in the residence.
14.
I understand that my eligibility to remain in housing is contingent on meeting program
expectations. The expectations include:
1.
Meeting at the residence weekly with my Inner Circle Caseworker
2.
Attending house meetings as scheduled by the Caseworker
3.
Following all housing policies and participating in household chores
4.
Actively working on the goals outlined in my TILP and Needs and Services Plan..
5.
Attending any other meetings scheduled regarding my participation in the program.
15.
I understand that I will have a 30-day evaluation for the first 90 days that I am in the
program. If I am not meeting the goals listed in my evaluation, I understand that I will need to
improve on them in the following 30-day period.
16.
I understand that I will be evaluated on a quarterly basis to ensure eligibility to receive
extended foster care. I am aware that eligibility includes meeting one of the following
requirements: employed at least 80 hours per month, completing high school or a GED program,
or enrolled at least part time in a college or vocational education program. I will supply my
Caseworker with documentation such as transcripts or paystubs if requested to do so.
17.
I understand that, because I am placed in scattered-site housing, Inner Circle staff will
only enter the residence for scheduled weekly meetings, in cases of emergency, and/or with 24
hour notice if entry is required for any other reason.
18.
I understand that Inner Circle will make its best effort to relocate me if residing in the
residence presents an imminent risk to my safety.
19.
I agree to notify my Caseworker in the event that I will be away from the residence for
three consecutive days or more. I understand that, if I am consistently staying somewhere other
than the assigned residence, then Inner Circle will take appropriate actions up to and including
dismissal from the program. I understand that, if I have not been living in my assigned residence
and have no contact with Inner Circle staff for over fourteen (14) days, I will receive an
Abandonment Notice and will be dismissed from the program.
20.
I understand that I am responsible for providing my own food, clothing,
recreational/entertainment, and cell phone service by budgeting my monthly stipend.
Acknowledgment of Receipt and Understanding of Admission Agreement
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Form 1: Admission Agreement
I have read and understand the above agreements and requirements for participating in Inner
Circle: Find your Way Home’s THP-NMD program. I agree to abide by all of the above
requirements.
I acknowledge that I have received a copy of this agreement and that a signed copy will be
placed in my file.
_____________________
________________________
__________
Client’s Name
Client’s Signature
Date
_____________________
________________________
__________
Caseworker’s Name
Caseworker’s Signature
Date
_____________________
________________________
__________
Program Admin’s Name
Program Admin’s. Signature
Date
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