AcknowledgmentI/we, Full name,acknowledge that Transcend STEM Education (herein referred to as the "Agency") and I/we (herein referred to as "the Client" or "Participant") have received, reviewed, and had the following policies and procedures explained to me/us.Program Rules•Once housed, I/we must follow all program rules. Any violation of may result in immediate removal from the program.• All concerns or issues related to my/our stay in the program must be reported to program staff immediately.• Housing protocols must be followed at all times. Violations may result in termination. These include but are not limited to:o Keeping housing clean and well maintained.o Not causing damage to housing units.o No subleasing or bringing in unapproved residents.o No fighting, physical assault, or disturbances among tenants or the public. Any such behavior will result in IMMEDIATE REMOVAL WITHOUT NOTICE.o No drug use, possession, sales, or illegal activity of any kind. (Zero Tolerance Policy- will result in IMMEDIATE REMOVAL WITHOUT NOTICE).Funding and Participation • Funding is first come, first served, and is based on eligibility and availability of funds.• The Agency may assist with transitioning out of homelessness, but payment of housing costs is not guaranteed and is contingent on eligibility, adherence to program rules, and available funding. • The Participant may be required to contribute all or part of housing or related costs, as outlined in the program agreement. •No guarantees or promises of permanent housing are made. •Participants must promptly notify program staff of any change in circumstances that may affect eligibility or housing status. For Transitional Housing Program Only: I/we need understand that Transcend STEM Education provides temporary housing only, and that an exit plan must be in place for moving to permanent housing. Client Privacy Policy:• Information collected may include name, birth date, and race/ethnicity, and optionally, social security number. • Data is stored securely using encryption, password protection, and two-factor authentication.• Only a limited number of authorized staff, who are bound by confidentiality agreements, may access this information.Termination Policy:• Failure to comply with program requirements (e.g., nonpayment of required contributions). • No longer meeting eligibility requirements (eg., income change).• Violation of the Zero Tolerance Drug and Illegal Activity Policy.Termination Procedure: The Agency may provide notice of termination by:• Written notice containing a clear statement of reasons, OR•Phone call advising the participant of the decision, OR• Mailed letter containing a clear statement of reasons. Participant Rights: • The Participant has the right to review the decision and present objections (in wiring or verbally) to someone other than the individual who made or approved the termination decision. • Termination does not prevent the Case Manager from providing future assistance at a later date. Hold Harmless/Indemnity• I/we agree to indemnify and hold harmless Transcend STEM Education and its affiliates from any claims, actions, or proceedings arising from my/our conduct, acts, or omissions whiles participating in the program. Acknowledgement of UnderstandingBy signing below, I/we acknowledge that:• The program requirements have been explained to me/us.• I/we have read and understood the above policies.•I/we agree to abide by these terms as a condition of participation.I declare under penalty of perjury that the foregoing is true and correct.
Agency Representative Signature:______________________
Date: ______________________