Opportunity Connect Individual and Family Assistance Request Form

  • Opportunity Connect Individual and Family Assistance Request Form

  • The Office of Youth and Young Adult Opportunities through the Opportunity Connect program links local communities to empowering resources and services designed to mitigate the impacts of violence, drugs, or gang participation while addressing unresolved trauma and supporting returning citizens.

    The goals of the program are to:

    · End the cycle of insufficient resources to meet the necessities of life and sustainability

    · Mitigate the cycle of trauma for individuals, families, and the community

    · Stop the needless loss of life by reducing drug, gang, and gun related violence;

    · Help individuals transitioning from incarceration identify support

    The purpose of this document is to establish the Scope of Work for a service or resource provided through the Opportunity Connect Program.

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  • Employment Services Information

    If your application is approved you will be asked for documentation to support your request. Likewise, all correspondence and award agreements will be generated from the information provided below.
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  • Other Family and Individual Services Information

    If your application is approved you will be asked for documentation to support your request. Likewise, all correspondence and award agreements will be generated from the information provided below.

  • Applicant Commitment Statement

    A commitment condition will justify funding if the Office of Youth and Young Adult Opportunities enters a contract with the Applicant. The Applicant will work with the Senior Family Services Coordinator upon receiving funding.
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  • Opportunity Connect Services and Assistance Terms and Conditions

  • • The applicant understands the Office of Youth and Young Adult Opportunities reserves the right to request the return of any funds provided and may initiate legal action by the city to collect such funds for failure to adhere to the commitment agreement.


    • However, if there are availability changes, the recipient may request an extension from the OYYAO Director, prior to 30 days from the date of application.

    • The City of Hampton or any of its Departments reserves the right to cancel this proposal with no liability.

    • This Service Request DOES NOT constitute a written agreement, contract, nor promise to initiate a contract between the Office of Youth and Young Adult Opportunities and the applicant, for education funding support or incentives.

    • Hold Harmless/Indemnification: Should a contract be entered, it is understood and agreed that the recipient hereby assumes the entire responsibility and liability for any and all damages to persons or property caused by, resulting from, or arising out of any act or omission on the part of the applicant. The applicant agrees to indemnify and hold harmless the City of Hampton, its agents, volunteers, servants, employees, and officials from and against any and all claims or suits due to, arising out of, or in connection with (a) any and all damages, real, or alleged; (b) the violation of any law applicable to this Agreement; and (c) the performance of the work by the applicant or those for whom the applicant is legally liable. Upon written demand by the City of Hampton, the applicants shall assume and defend at the applicant’s sole expense, any and all such suits or defense claims made against the City of Hampton, its agents, volunteers, servants, employees, or officials.

    • Modification: Should a contract be entered into with the applicant, there may be no modification to the contract or donation agreement, except in writing, executed by the authorized representatives for the Office of Youth and Young Adult Opportunities and the applicant.

    • Non-Assignment: Should a contract or donation agreement be entered into with the applicant there will be no assignment of its rights and duties under the contract, without the prior, written consent of the Office of Youth and Young Adult Opportunities.

    • All economic assistance SHALL NOT be made directly to the applicant but to the designated service provider, or given to the individual in the form of a gift card purchased directly by the Office of Youth and Young Adult Opportunities.


    This Proposal for Services DOES NOT constitute a written agreement, contract, nor promise to initiate a contract between the Office of Youth and Young Adult Opportunities and the applicant.

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