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  • Client Application and Contract

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  • Confidentiality Statement

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  • RECITALS

    The Receiving Party understands that the Disclosing Party has disclosed or may disclose information relating to Flourishing Families, which to the extent previously, presently, or subsequently disclosed to the Receiving Party is hereinafter referred to as "Proprietary Information" of the Disclosing Party.

    OPERATIVE PROVISIONS

    1.  In consideration of the disclosure of Proprietary Information by the Disclosing Party, the Receiving

    Party hereby agrees:

    (i)                        to hold the Proprietary Information in strict confidence and to take all reasonable precautions to protect such Proprietary Information (including, without limitation, all precautions the Receiving Party employs with respect to its own confidential materials),

    (ii)                      not to disclose any such Proprietary Information or any information derived there from to any third person,

    (iii)                    not to make any use whatsoever at any time of such Proprietary Information except to evaluate internally its relationship with the Disclosing Party, and

    (iv)                    not to copy or reverse engineer any such Proprietary Information. The Receiving Party shall procure that its employees, agents and sub-contractors to whom Proprietary Information is disclosed or who have access to Proprietary Information sign a nondisclosure or similar agreement in content substantially similar to this Agreement

    2.  Without granting any right or license, the Disclosing Party agrees that the foregoing shall not apply with respect to any information after five years following the disclosure thereof or any information that the Receiving Party can document:

    (i)                is or becomes (through no improper action or inaction by the Receiving Party or any affiliate,         agent, consultant or employee) generally available to the public, or

    (ii)               was in its possession or known by it prior to receipt from the Disclosing Party as evidenced in writing, except to the extent that such information was unlawfully appropriated, or was rightfully disclosed to it by a third party, or

    (iii)               was independently developed without use of any Proprietary Information of the Disclosing Party. (iv)               The Receiving Party may make disclosures required by law or court order provided the Receiving Party uses diligent reasonable efforts to limit disclosure and has allowed the Disclosing Party to seek a protective order.

    3.   Immediately upon the written request by the Disclosing Party at any time, the Receiving Party will return to the Disclosing Party all Proprietary Information and all documents or media containing any such Proprietary Information and any and all copies or extracts thereof, save that where such Proprietary Information is a form incapable of return or has been copied or transcribed into another document, it shall be destroyed or erased, as appropriate.

    4.  The Receiving Party understands that nothing herein

    (i)               requires the disclosure of any Proprietary Information or

    (ii)              requires the Disclosing Party to proceed with any transaction or relationship.

    5.  The Receiving Party further acknowledges and agrees that no representation or warranty, express or implied, is or will be made, and no responsibility or liability is or will be accepted by the Disclosing Party, or by any of its respective directors, officers, employees, agents or advisers, as to, or in relation to, the accuracy of completeness of any Proprietary Information made available to the Receiving Party or its advisers; it is responsible for making its own evaluation of such Proprietary Information.

    6.  The failure of either party to enforce its rights under this Agreement at any time for any period shall not be construed as a waiver of such rights. If any part, term or provision of this Agreement is held to be illegal or unenforceable neither the validity, nor enforceability of the remainder of this Agreement shall be affected. Neither Party shall assign or transfer all or any part of its rights under this Agreement without the consent of the other Party. This Agreement may not be amended for any other reason without the prior written agreement of both Parties. This Agreement constitutes the entire understanding between the Parties relating to the subject matter hereof unless any representation or warranty made about this Agreement was made fraudulently and, save as may be expressly referred to or referenced herein, supersedes all prior representations, writings, negotiations or understandings with respect hereto.

    7.  This Agreement shall be governed by the laws of the jurisdiction in which the Disclosing Party is located (or if the Disclosing Party is based in more than one country, the country in which its headquarters are located) (the "Territory") and the parties agree to submit disputes arising out of or in connection with this Agreement to the non-exclusive of the courts in the Territory.

  • Personal History/ Medical History

  • Employment History

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  • Verification and ID

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  • Below are the accepted Identification Preferences.

    State Drivers License

    Passport (Not Expired)

    State ID

    Military ID

  • Grievance Policy

  • This grievance procedure is designed to provide a means for Flourishing Families clients to bring grievances concerning the manner in which they are being served at Flourishing Families to the attention of management to reach a speedy resolution.  Flourishing Families has a strict policy prohibiting retaliation in any form against any client.

    A grievance is defined as any cause of distress or any relevant condition that a client reasonably thinks or feels is unfair, unjust, or inequitable.  Under this Client Grievance Procedure, clients should address a grievance in the following manner:

    • Any grievance should first be discussed with the client’s counselor or case worker.  It the client is more comfortable sharing their concern directly with a supervisor they may do so.  The client should be aware however, that the supervisors will share any concerns with the appropriate counselor or case worker.  Open discussions can often address the concern and resolve the issue satisfactorily.  If, however, the client is not satisfied with the outcome after these discussions, they may initiate a formal Grievance Resolution Process.
    • At this step, the client should describe in writing the nature of their grievance and submit the grievance to Flourishing Families Founders email:  flourishingfamilies@hotmail.com or US Mail: Flourishing Families 2041 Madison St Clarksville TN 37043.  One of the founders will initiate an investigation of the grievance within two business days.  The founder will share the grievance with the appropriate counselor or case worker and determine whether correctable action is indicated.  The client may be asked to meet with their counselor or case worker, supervisor and Founder.
    • Flourishing Families will endeavor to expedite this process, but the actual amount of time taken will depend on a variety of factors, including the availability of all the staff members involved, however in no event will the investigation take longer than ten business days unless extenuation circumstances exist which require additional time for resolution.  Should this occur the client will be notified within 10 days of the need to continue the investigation?
    • All written responses will be provided to the client with a copy placed in their file.
    • The Founder will be responsible for reporting on the nature of the compliant and resolution at the agency’s next Board of Director meeting.
    • If for any reason the client is dissatisfied with the results of the resolution reached by Flourishing Families and believes that the organization is not in compliance with regulations then they should contact Legal Aid Clarksville TN for assistance in the matter.
  • Program Process

  • I, the client, understand that once I submit this paperwork to Flourishing Families that I am required to follow the guidelines for making my living situation better. All service that is provided to me comes with the understanding that I will attend appointments, classes, meetings and gatherings that are meant for me.  If for some reason I cannot meet at a particular time I will inform my caseworker and reschedule for a better time.

    I, the client, understand the rent, utilities, and any other bills are my responsibility regardless of the services that I receive from Flourishing Families.  Goals and performance will be measured once I enroll into the program.  My continuation in the program will be deteremined by my performance and meeting the goals that my caseworker and I set. 

    We, Flourishing Families, will provide Financial and Career Building Classes.

  • Signature and Submission

  • Please type your name below stating that you understand the program guidelines and what is required of you.

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  • Please note, all applicants will be required to attend an appointment prior to being accepted into the Second Chance, Fresh Start, or Bridging the Gap Program. Additional information will be required upon attendance to the application review, such as social security cards, birth certificates, rental/lease agreements, and other supporting documentation.  Clients that set and appointment but lack the correct paperwork, will have to set another appointment at a future date. 

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