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fy23 teen court program agreement executedDocuSign Envelope ID: 9D6D37A6-1DDA-4A15-8E41-C2679ECBF5D6 Wor"Ap- North Carolina Department of Public Safety JCPC Program - Program Agreement SECTION I A SPONSORING AGENCY AND PROGRAM INFORMATION FUNDING PERIOD: FY 22-23 DPS/JCPC FUNDING # (cont only) 865-XXXX COUNTY: New Hanover AREA: Eastern Area Multi -County: No Multi -Components Yes NAME OF PROGRAM: Teen Court & Mediation (Restorative Justice) SPONSORING AGENCY: Communities In Schools of Cape Fear SPONSORING AGENCY 20 N. 4th St. Suite 213 PHYSICAL ADDRESS: Wilmington NC 28401 SPONSORING AGENCY 20 N. 4th St. Suite 213 MAILING ADDRESS: Wilmington NC 28401 TYPE: Non -Profit (910) 343-1901 FEDERAL ID #120-3385755 E-mail: Louise@ciscapefear.org COMPONENT ID # NAME OF PROGRAM COMPONENT PROGRAM TYPE TOTAL COST OF EACH COMPONENT 34467 Teen Court Teen Court $ 69,402 34468 Mediation / Restorative Justice Mediation/Conflict Resolution $ 43,443 Total cost of components: $ 112,845 Program Manager Name & Address (same person on signature page) Name: Louise Hicks Title: Executive Director Mailing Address: 20 N. 4th St. City: Wilmington Zip: 28401 Suite 213 Phone: (910) 343-1901 Fax: E-mail: Louise@ciscapefear.org Contact Person (if different from program manager) Name: Louise Hicks Title: Executive Director Mailing Address: 20 N. 4th St. City: Wilmington Zip: 28401 Suite 213 Phone: (910) 343-1901 Fax: E-mail: Louise@ciscapefear.org Program Fiscal Officer (cannot be program manager) Name: Jennifer Haslam Title: Finance Support Mailing Address: 20 N. 4th St. City: Wilmington Zip: 28401 Suite 213 Phone: (910) 343-1901 Fax: E-mail: Jen@ciscapefear.org Form JCPC/PA 001 JCPC Program Agreement Form structure last revised 12/31/2012 Department of Public Safety DocuSign Envelope ID: 9D6D37A6-1 DDA-4A15-8E41-C2679ECBF5D6 SECTION I B PROGRAM COMPONENT DESCRIPTION COMPONENT ID # COMPONENT INFORMATION 34467 NAME OF COMPONENT: Teen Court BRIEF DESCRIPTION: CIS Teen Court will provide New Hanover County youth with an opportunity for diversion from juvenile court. Trained adult and teen volunteers will act as court officials and hear complaints against eligible offenders who are currently enrolled in school, admit guilt, and have no prior criminal history. Appropriate sentencing recommendations will be made including community service, restitution, restorative justice, and participation in future Teen Court proceedings and skill -building programs. COMPONENT ID # COMPONENT INFORMATION 34468 NAME OF COMPONENT: Mediation / Restorative Justice BRIEF DESCRIPTION: The CIS Mediation/Restorative Justice program is designed to mediate disagreements between youth ages 11-18, who have been referred by SROs, law enforcement officials, school administrators, or juvenile court staff. Recognizing that students need to learn how to resolve conflicts, staff trained in mediation and/or restorative Justice practices will guide referred youth through a structured process in an effort to help them come to a positive resolution. Form JCPC/PA 001 JCPC Program Agreement Form structure last revised 12/31/2012 Department of Public Safety DocuSign Envelope ID: 9D6D37A6-1DDA-4A15-8E41-C2679ECBF5D6 SECTION II COMPONENT STATISTICAL INFORMATION Multi -Components Yes Component Service Statistics PROGRAM COMPONENT INFORMATION - APPLICATION YEAR Component Name: Teen Court Component ID # 34467 What is this component's maximum client capacity at any given time? 30 Frequency of client contact per month: 4 Anticipated Average Length of Stay: 100 Days y Total Component Cost: $69,402 - by Estimated # to be served during funding period: 60 Estimated Average Cost Per Youth: $1,157 Actual number of youth admitted FY 20-21: 0 Applies to 0 Number of admissions Juvenile Justice Referred 0% of total admissions continuation 0 Number of admissions Law Enforcement Referred 0% of total admissions programs only. 0 Number of admissions District Court Referred 0% of total admissions Actual number served FY 20-21: 0 Form JCPC/PA 001 JCPC Program Agreement Form structure last revised 01/09/2012 Department of Public Safety DocuSign Envelope ID: 9D6D37A6-1DDA-4A15-8E41-C2679ECBF5D6 SECTION III I COMPONENT SUMMARY NAME OF COMPONENT: I Teen Court 1. Statement of the Problem: In concise terminology, describe how the program will address continuum need(s) in the county. The juvenile court system in New Hanover County needs to maintain court diversion programs for low-level, youth offenders. NC DPS Division of Juvenile Justice County Databook 2020 reported 782 juvenile complaints and a delinquency rate of 26.33. Of those, 373 (47%) were minor Class 1-3 offenses. These types of defendants are less likely to re -offend. The latest available DPI Consolidated Data Report shows New Hanover County Schools had 74 reportable crimes, or 9.175 per 1.000, with 2,910 short-term suspensions and 10 long-term. The New Hanover County Risk and Needs Assessment 2020-2021 shows 62% of youth are moderate to high risk and 57% have a legal history. 49% report moderate to serious school discipline issues. 73% report difficulty with positive peer relationships, have some association or regularly associate with delinquent peers, or have gang association. 40% have prior assaultive behavior and 25% have had at least two or three prior referrals. 47% of youth are prior runaways or have been victims of child neglect, above the state rate of 34%. Additionally, incidents involving a weapon and assaultive behavior are above the state rate, as are incidents involving sexual vulnerability, victim or bullying and/or assault are also above the state rate in all three areas. CIS Teen Court will offer an alternative to juvenile court and an opportunity for first-time offenders to avoid a court record/ It will provide comprehensive intervention and support to the juvenile participants and will focus on diversion of misdemeanor offenses. Per the Juvenile Reinvestment Report from N.C. Commission on the Administration of Law and Justice, evidence -based research suggests adolescents are less culpable than adults; the majority of youth offenders age out of the behavior with full maturity. CIS Teen Court will offer the opportunity to learn skills to manage negative behavior. CIS Teen Court will provide juveniles with a multi -faceted plan including Restorative Circles, essays/apology letters, future jury duty, monitoring of school attendance and academics, and referrals to restitution opportunities. Success in sentence completion and program participation will be monitored, and participants will be tracked one-year post - sentence completion to determine recidivism. CIS Teen Court will support protective factors to address the continuum of risk and needs in New Hanover County by providing evidence- and/or research -based programs shown to be effective with juvenile offenders; providing services that are outcome -based and evaluated; and collaborating with SRO's, the WPD, and the NHC Sheriff's Office to detect gang participation and make referrals to diversion programming. Additional benefits include addressing juvenile and family needs with a focus on prevention and education and providing opportunities for effective service provider collaboration. 2. Target Population: Describe the target population, including age, and the steps taken to insure that the target population is served. Our target population is youth, ages 11-18, who have been petitioned or law enforcement referred for low-level offenses. Partnerships with SROs, Juvenile Services, and District Court will allow these juvenile offenders the opportunity to participate in the Teen Court program if the Court Intake Counselor finds they are eligible, willing to admit responsibility for their actions, and willing to complete the program. If the offender successfully completes Teen Court sentencing requirements within a 90 -day period, his/her record will be completely cleared. The program will also provide opportunities, as applicable and at certain school sites, for participants to receive additional services at no cost, including but not limited to Restorative Justice Circles and Integrated Student Supports. Additionally, at -risk youth and first-time offenders will be encouraged to volunteer in the program at the end of their sentence, continuing Form JCPC/PA 001 JCPC Program Agreement Form structure last revised 12/31/2012 Department of Public Safety DocuSign Envelope ID: 9D6D37A6-1DDA-4A15-8E41-C2679ECBF5D6 SECTION III COMPONENT SUMMARY NAME OF COMPONENT: Teen Court beneficial services and interaction with pro -social peers. A secondary population served by Teen Court is the parents/guardians of these juveniles. Through deep -reaching partnerships, CIS will strive to refer families to parenting education and support groups that focus on improving parenting skills and parent/child relationships, whereby introducing a preventative component to this intervention, as other siblings in the household may avoid the juvenile justice system by being exposed to better parenting and less discord. By focusing both the juvenile and the family on developing better coping skills, positive social activities, and peer groups, and enhancing their knowledge and ability to have more positive interactions within their family, we will reduce the risk of re -offending or having other family members enter the juvenile justice system. 3. Program Goal(s): Provide a brief statement to describe the overall purpose of the program. The primary goal of the program is to reduce the number of juvenile offenders entering the court system. Juveniles accept responsibility for their actions and are held accountable by their peers. Defendants will receive sentences and for community service/restitution, jury duty at future Teen Court sessions, writing letters of apology, and counseling/educational sessions to learn coping mechanisms, and learn effective communication skills with peers/ parents/authority figures. Opportunities will be provided for juvenile offenders to participate in Restorative Justice Circles and in -school support services at no additional cost. Parents will be referred to programming to help them learn parenting skills, positive disciplinary techniques, and communication skills in addition to problem -solving current areas of concern. Through successful participation in Teen Court, a defendant can avoid a juvenile court record, which would negatively affect his/ her opportunities to enter college, trade school, the military, or obtain employment. 4. Measurable Objective(s): State in measurable terms (%) the intended effect of the program on specific undisciplined and/or delinquent behaviors. Example: anticipated reductions in court referrals, runaway behavior, disruptive behavior at school, anticipated improved school attendance and academic achievement. These objectives must include impact on participants. 70% Clients will demonstrate improvement in developing and/or maintaining social and interpersonal interactions during program participation. 70% Clients successfully/satisfactorily completing the program will have no new adjudications in the 12 months following completion. 90% Clients will successfully or satisfactorily complete services as intended by the program design/service plan. 70% Clients will have no new complaints with an offense date after the admission date. 70% Clients successfully/satisfactorily completing the program will have no new complaints in the 12 months following completion. 70% Clients will have no new adjudications for a complaint with an offense date after the admission date. 5. Elevated Risks and Needs: Describe how program services will address one or more of the elevated risk and needs listed in the most recent JCPC Request for Proposal. The juvenile court system in New Hanover County needs to maintain court diversion programs for low-level, youth offenders. NC DPS Division of Juvenile Justice County Databook 2020 reported 782 juvenile complaints and a delinquency rate of 26.33. Of those, 373 (47%) were minor Class 1-3 offenses. These types of defendants are less likely to re -offend. The latest available DPI Consolidated Data Report shows New Hanover County Schools had 74 Form JCPC/PA 001 JCPC Program Agreement Form structure last revised 12/31/2012 Department of Public Safety DocuSign Envelope ID: 9D6D37A6-1DDA-4A15-8E41-C2679ECBF5D6 SECTION III I COMPONENT SUMMARY NAME OF COMPONENT: I Teen Court reportable crimes, or 9.175 per 1.000, with 2,910 short-term suspensions and 10 long-term. The New Hanover County Risk and Needs Assessment 2020-2021 shows 62% of youth are moderate to high risk and 57% have a legal history. 49% report moderate to serious school discipline issues. 73% report difficulty with positive peer relationships, have some association or regularly associate with delinquent peers, or have gang association. 40% have prior assaultive behavior and 25% have had at least two or three prior referrals. 47% of youth are prior runaways or have been victims of child neglect, above the state rate of 34%. Additionally, incidents involving a weapon and assaultive behavior are above the state rate, as are incidents involving sexual vulnerability, victims of bullying, and/or assault are also above the state rate in all three areas. CIS Teen Court will complete a basic risk assessment at intake and will work with community partners to ensure emotional/mental health needs or issues from trauma are referred for proper assessment and intervention. CIS Teen Court will provide sentencing requirements that engage defendants in positive social situations and promote pro -social behaviors, which may include community service, apology letters, participation in mediations, Restorative Justice Circles, and serving as a juror at future Teen Court sessions. Juveniles will also be required to attend school, maintain satisfactory grades and show positive conduct, with compliance tracking. Addressing the needs of both the juvenile and family will be key to the success of CIS Teen Court. As appropriate, parents will be referred to educational classes and/or parenting groups to learn the importance of peer relationships and developing skills and confidence to help their teens establish new behavior patterns. In doing so, a shared sense of purpose will be established as they work together to improve behaviors and interactions with one another and their community. This multi -faceted family support approach will also help deter juveniles' siblings from entering the juvenile court system. Form JCPC/PA 001 JCPC Program Agreement Form structure last revised 12/31/2012 Department of Public Safety DocuSign Envelope ID: 9D6D37A6-1DDA-4A15-8E41-C2679ECBF5D6 SECTION IV COMPONENT NARRATIVE (attach for each component) NAME OF COMPONENT: Teen Court 1. Location: List physical address(es) and describe where program services are delivered. The CIS Teen Court / Mediation (Restorative Justice) Coordinator and Assistant will work out of the CIS offices both at The Harrelson Center, 20 N. 4th Street, Wilmington, NC 28401, and at the CIS WIRE Youth Center, 1102 Orange Street, Wilmington, NC 28401, where they will meet with juvenile offenders and their families and complete administrative duties to support the successful operation of CIS Teen Court. Through our existing and strong relationship with New Hanover County Schools, they will also have access to space within the district's schools for those meetings upon SRO referral, to enable ease of access for parents and juvenile offenders. CIS Teen Court sessions will be held in designated areas within the New Hanover County Juvenile Justice Building. Restorative Justice Circles and Mediations will be held at relevant school sites, or at the CIS youth center, WIRE, at 1102 Orange Street. Parenting programs will be held according to the implementing organizations' location and schedules. 2. Operation: Describe the daily/weekly schedule of program operation. The CIS Teen Court / Mediation (Restorative Justice) Coordinator and Assistant will work out of the CIS offices both at The Harrelson Center and 1102 Orange Street, where they will meet with juvenile offenders and their families and complete administrative duties that will support the successful operation of CIS Teen Court. Through our existing and strong relationship with New Hanover County Schools, they will also have access to space within the district's schools for those meetings upon SRO referral, to enable ease of access for parents and juvenile offenders. The Coordinator will be available 5 days per week at either their office location or via cell phone, and at other times via cell phone if needed. All records and equipment will be kept in a secured area that will be closed to the public. CIS Teen Court sessions will be held in designated areas within the New Hanover County Juvenile Justice Building. Restorative Justice Circles and Mediations will be held at relevant school sites, or at the CIS youth center, WIRE, at 1102 Orange Street. Parenting programs will be held according to the implementing organizations' schedules. Referrals will be accepted daily from Student Resource Officers, DJJDP; Law Enforcement and/or District Court Counselors. CIS Teen Court will be held at least once a month. In addition to traditional Teen Court proceedings held monthly at the courthouse utilizing a full jury, attorney mentors, and a judge, tribunals may held when a defendant is unable to participate in a full peer jury court room hearing due to an identified mental, emotional, learning or other disability that makes it unlikely he/she can successfully participate in those proceedings. The same sentencing guidelines and all other Teen Court processes will be adhered to during a tribunal. The other time a tribunal may be used is when it is not appropriate or is detrimental to delay a case due to a lack of adequate peer jurors, attorney mentors, and/or judges to hear a case. In that situation, at the discretion of the Teen Court Coordinator, a tribunal may be held. 3. Staff Positions: Describe paid or volunteer position qualifications, (certifications, degrees, work experience) and position(s) responsibilities relative to this component. The CIS Teen Court / Restorative Justice Coordinator and assistant will be supervised by the CIS Director of Operations, Marrio Jeter. Along with the program coordinator, Mr. Jeter will attend JCPC meetings and provide reports on program progress at monthly meetings. He will supervise the Teen Court Coordinator, providing feedback and oversight, and ensuring compliance with program fidelity and grant reporting. CIS leadership will also be responsible for community awareness of the Teen Court program and ensuring all other funding sources and in-kind supports are in place to support the program. Form JCPC/PA 001 JCPC Program Agreement Form structure last revised 12/31/2012 Department of Public Safety DocuSign Envelope ID: 9D6D37A6-1DDA-4A15-8E41-C2679ECBF5D6 SECTION IV COMPONENT NARRATIVE (attach for each component) NAME OF COMPONENT: Teen Court The CIS Teen Court / Restorative Justice Coordinator will have a minimum of a bachelor's degree in criminal justice, education, or human services related field, and be a trained mediator. They will have extensive experience working with at -risk youth and their families, possess excellent communication skills, be detail oriented, and work well with both parents and teens. They will be responsible for all aspects of the program, including but not limited to maintaining and/ or building relationships with referring entities, accepting referrals, interviewing defendants/parents, recruiting/ training volunteers, collecting data, referring to and scheduling, as needed, counseling/ education/support sessions, evaluating defendants' completion of program, attending JCPC monthly meetings, and reporting outcomes to stakeholders. The CIS Teen Court / Restorative Justice Assistant will have a minimum of a bachelor's degree in criminal justice, education, or human services related field, and extensive experience working with at -risk youth and their families. In addition to assisting with the facilitation of CIS Teen Court and Mediation / Restorative Justice programs, they will support volunteer recruitment, marketing, community outreach, partnership development, and other duties as assigned. The Administrative Support personnel will manage payroll for the project staff, manage accounts payable and receivables as related to the project, and prepare monthly revenue and expense reports. Teen Court Aides will be present for each of the CIS Teen Court Sessions, and will have experience volunteering with prior Teen Court sessions. They will monitor student volunteers, confirm positions, record and confirm the adult jury monitors, ensure jury sign -in sheets are renewed between defendants, maintain the sentencing and disposition sheet, ensure required participant surveys are completed, and perform other administrative duties as assigned. Adult volunteers, including local attorneys and judges will serve. as judges, attorney mentors, jury monitors and role models. Teen volunteers will serve as attorneys and jury members. 4. Service Type SPEP: Describe implementation to include: This program is a STRUCTURE ONLY. 5. Admission Process: Describe the specific referral, screening, admission process (including timeline), the staff responsible for making decisions about admissions and reasons why a referral may not be accepted. Referrals may be made by school resource officers, law enforcement, juvenile justice, district court, or area attorneys for youth ages 11-18 who have committed an offense of less than an Al misdemeanor. The Teen Court Coordinator will make contact with the juvenile & their parent/guardian upon referral. A referral will not be accepted if the offender is over 18 years of age at the time of offense, if the offender or parent/ guardian are not willing or able to complete all requirements of the Teen Court process, or if the offender has a record of prior offenses. If the offense is outside the parameters of offenses intended to be diverted to Teen Court, a referral to Juvenile Court would be made. To be eligible for Teen Court, offenders must admit responsibility for their actions and be willing to complete the program. An intake appointment will be arranged to review program guidelines, participation requirements, completion dates, expected outcomes, obtain informed consent to participate, review consequences for non-compliance and obtain signatures agreeing to terms. A court date will be set for the offender at this appointment during which a sentence will be delivered by a jury of the offender's peers. Form JCPC/PA 001 JCPC Program Agreement Form structure last revised 12/31/2012 Department of Public Safety DocuSign Envelope ID: 9D6D37A6-1DDA-4A15-8E41-C2679ECBF5D6 SECTION IV I COMPONENT NARRATIVE (attach for each component) NAME OF COMPONENT: I Teen Court The Teen Court Coordinator will be responsible for conferring with the referral source for each case to ensure the referral is appropriate for Teen Court and that all relevant, required information has been provided to hear the case and determine sentencing. If the parent and student refuse to participate in the Teen Court Program, the Teen Court Coordinator will immediately notify the referral source. It is also the responsibility of the Teen Court Director to monitor all sentencing completion in determining the defendant's successful or unsuccessful completion of the Teen Court Program. Upon arrival to Teen Court, the juvenile will meet with students assigned as their attorneys and their adult attorney mentor. The trial, designed to mirror a genuine court proceeding, will begin and mitigating/ aggravating factors will be presented. The sentence may include up to 20 hours of community service/restitution, participation on the jury of future Teen Court sessions, participation in Restorative Justice Circles, letters of apology, maintaining all lawful commands of parents, and school attendance and grades. The defendant and their parent will be required to sign the Sentencing Form at the conclusion of their hearing and will then be referred to the County's Restitution Program for completion of community service. Offenders must complete their sentence within a maximum of 90 days, stay in school and not re -offend during their stay in Teen Court. Parents are required to attend intake, attend court with their child, and attend any supports to which they are referred. If a juvenile fails to complete his/her sentencing terms as required, his/her case will be sent back to referring agency for further disposition. 6. Termination Process: Describe the termination process to include the staff responsible for making decisions and the criteria for a successful termination, satisfactory termination, unsuccessful completion and non-compliant termination. Upon sentencing completion, an exit interview will be conducted with both the defendant and their parent/guardian to review the defendant's progress. Emphasis will be placed on lessons learned, and on developing plans and goals for the future. The juvenile will be followed for 1 year after sentence completion to track recidivism. The Teen Court Coordinator will meet with/notify the referring agency as to the successful program completion of the juvenile. Any action other than a successful completion will be reviewed with the referring agency, parent and juvenile. Any juvenile offender who does not successfully complete Teen Court and comply with all guidelines will be deemed non-compliant, terminated from Teen Court and referred back to the referring agency. Reasons for unsuccessful completions would be if the offender re -offended either at school or within the community between their intake appointment and the 90 -day deadline for completion, or not completing any aspect of the program within the agreed-upon 90 -day window. Other terminations will include: - Refusal to participate in the program (at which point the offender will be referred back to the initial referring agency). - Moving out of state / County - Involuntary commitment of the offender How is the referring agency involved with the termination process? The Court Intake Counselor, Law Enforcement, School Resource Officer, and/or District Attorney's Office will be notified by the Teen Court Coordinator of successful sentence completion. Any action other than a successful completion will be reviewed with the referring agency, parent, and the juvenile, who will then be referred back to the referring party for disposition. Form JCPC/PA 001 JCPC Program Agreement Form structure last revised 12/31/2012 Department of Public Safety DocuSign Envelope ID: 9D6D37A6-1DDA-4A15-8E41-C2679ECBF5D6 SECTION IV I COMPONENT NARRATIVE (attach for each component) NAME OF COMPONENT: I Teen Court 7. Referring Agency Interaction: Describe the interaction with juvenile court counselors and/or other referring agencies including how client progress will be communicated. Referrals may be made by school resource officers, law enforcement, juvenile justice, district court, or area attorneys for youth ages 11-18 who have committed an offense of less than an Al misdemeanor. The Teen Court Coordinator will make contact with the juvenile & their parent/guardian upon referral. A referral will not be accepted if the offender is over age 18 at the time of the offense, if the offender or parent/ guardian is not willing or able to complete all requirements of the Teen Court process, or if the offender has a record of prior offenses. If the offense is outside the parameters of offenses intended to be diverted to Teen Court, referral to Juvenile Court would be made. The Teen Court Coordinator will be responsible for conferring with the referral source for each case to ensure the referral is appropriate for Teen Court and that all relevant, required information has been provided to hear the case and determine sentencing. If the parent and student refuse to participate in the Teen Court Program, the Teen Court Coordinator will immediately notify the referral source. It is also the responsibility of the Teen Court Director to monitor all sentencing completion in determining the defendant's successful or unsuccessful completion of the Teen Court Program. The program coordinator will be in constant contact with the referral source throughout the intake, enrollment, and teen court process. The defendant and their parent will be required to sign the Sentencing Form at the conclusion of their hearing and will then be referred to the Restitution Program for completion of their sentence, which must be completed within a maximum of 90 days. They must also stay in school and not re -offend during their Teen Court participation. Parents are required to attend intake and court with their child, and attend any supports to which they are referred. If a juvenile fails to complete his/her sentencing terms as required, his/her case will be sent back to the referring agency for further disposition. Continued communication with the referring entity will be critical for feedback to the program coordinator. 8. Intervention/Treatment: Describe specifically what the component will do to redirect inappropriate youth behavior or how the component will address the identified needs of the youth and family. What interventions will typically be utilized in this component and how will parents/guardians be involved? A structured service plan of learning (Sentence) will be developed for defendants to address behavior problems, drug - alcohol prevention and peer pressure. Sentencing will hold youth accountable for future actions including school attendance, achieving satisfactory grades, and not committing further offenses. Educational workshops for youth will provide skills to improve juvenile's decision making, communication, conflict resolution, and gang and drug resistance, thereby reducing negative behaviors. Participation in future Teen Court jury duty will increase the defendant's access to positive peers. Completion of community service will provide exposure to pro -social activities , positive role models and volunteerism, supporting positive character development. By attending the referred parenting classes as applicable, parents/guardians can learn better disciplinary techniques and communication that can be applied when working with their children, thus empowering them to become more effective, proactive parents. Youth listen to and are influenced by their peers. Juveniles who are held accountable for their behavior by their peers are more likely to listen and make changes to their behavior. Volunteer jurors recognize and "reward" positive behaviors such as after-school involvement, satisfactory grades, commitment to stay in school, and future goals, as seen in their jury verdict. In order to complete their constructive sentence, juveniles and their families work on family accountability and relationships. Form JCPC/PA 001 JCPC Program Agreement Form structure last revised 12/31/2012 Department of Public Safety DocuSign Envelope ID: 9D6D37A6-1DDA-4A15-8E41-C2679ECBF5D6 SECTION IV I COMPONENT NARRATIVE (attach for each component) NAME OF COMPONENT: I Teen Court Healthy attitudes concerning family, discipline, consequences and education are encouraged and reinforced in peer circles and parenting groups. Community Service allows youth to work and learn from adults who support community activities and allows them to be exposed to positive activities that also serve others. Incentives, usually in the form of a snack prior to the start of each Teen Court session or a year end gathering for recognition of service, is provided to students who volunteer their time to hear the cases of their peers. The use of incentives helps contribute to their commitment to the program and shows they are appreciated and valued as part of the Teen Court process. 9. Best Practice Model: Describe what model or evidence-supported/best practice the program is based upon. CIS Teen Court program will use the National Youth Court Guidelines - authored by Tracy Godwin with Michelle Heward and Thomas Spina. According to the National Center for Mental Health Promotion and Youth Violence Prevention, "these best practice guidelines were developed by a panel of experts in the following program areas: program planning and community organization, program staffing and funding, legal issues, identified respondent population and referral process, program services and sentencing options, volunteer recruitment and management, volunteer training, operations and case management, and program evaluation. Guidelines were developed to promote best practices, effectiveness, and program accountability." Restorative practices to deal with crime and wrongdoing are recognized as evidence -based practices according to extensive research and there is support now too that restorative justice is evidence -based for school discipline. The Council of State Governments issued a report in 2014 and recommends restorative practices for school discipline and states that it is evidence based along with other interventions including Positive Behavioral Interventions and Support (PBIS). p. 14 (http://csgjusticecenter.org/wpcontent/uploads/2014/06/ The_School_Discipline_Consensus_Report.pdf) The CIS Model of Integrated Students Supports is supported by research from organizations including Child Trends and the Everyone Graduates Center at Johns Hopkins University. Child Trends asked the question, "Does ISS Work?" and embarked on a comprehensive and rigorous review of the "theoretical, empirical, practice and evaluation findings that underlie integrated students supports as an approach". (Child Trends White Paper, February 2014) Key findings support the CIS Model. Emerging evidence from quasi -experimental studies (including CIS National) finds that ISS can contribute to decreases in grade retention and school dropout, and increases in attendance, math achievement and overall GPA. As a student -centered approach, ISS is firmly grounded in the research on child and youth development. Providing an array of academic and non-academic supports in a coordinated manner (as in the CIS Model) is more effective than a focus on one or a few supports. Child Trends concludes that evidence supports the effectiveness and cost-effectiveness of integrated student supports to improve educational outcomes. Additionally, all mediation and Restorative Justice Circle facilitators will have been formally trained and/or certified to implement the respective intervention / support with fidelity. Form JCPC/PA 001 JCPC Program Agreement Form structure last revised 12/31/2012 Department of Public Safety DocuSign Envelope ID: 9D6D37A6-1DDA-4A15-8E41-C2679ECBF5D6 SECTION II COMPONENT STATISTICAL INFORMATION Multi -Components Yes Component Service Statistics PROGRAM COMPONENT INFORMATION - APPLICATION YEAR Component Name: Mediation / Restorative Justice Component ID # 34468 What is this component's maximum client capacity at any given time? 15 Frequency of client contact per month: 4 Anticipated Average Length of Stay: 90 Days y Total Component Cost: $43,443 - by Estimated # to be served during funding period: 40 Estimated Average Cost Per Youth: $1,086 Actual number of youth admitted FY 20-21: 0 Applies to 0 Number of admissions Juvenile Justice Referred 0% of total admissions continuation 0 Number of admissions Law Enforcement Referred 0% of total admissions programs only. 0 Number of admissions District Court Referred 0% of total admissions Actual number served FY 20-21: 0 Form JCPC/PA 001 JCPC Program Agreement Form structure last revised 01/09/2012 Department of Public Safety DocuSign Envelope ID: 9D6D37A6-1DDA-4A15-8E41-C2679ECBF5D6 SECTION III I COMPONENT SUMMARY NAME OF COMPONENT: I Mediation / Restorative Justice 1. Statement of the Problem: In concise terminology, describe how the program will address continuum need(s) in the county. Conflict between youth in a school or community setting is a natural occurrence and is typically thought of in a negative way, however that perception can be re -framed to view conflict as an opportunity for growth. Mediation and restorative justice practices are tools that can be utilized to help facilitate this growth and to promote positive conflict resolutions. Conflict presents itself in almost every facet of our lives at some point, so we should equip youth at an early age with skills they need to positively resolve conflict, whereby avoiding escalation of the conflict, or leading to more negative, potentially criminal behaviors. Peer relationships are the focal point of adolescent development and our youth need to be educated in conflict resolution in an effort to support healthy relationships and yield positive outcomes. When conflicts occur, most youth lack the developmental maturity to resolve issues without adult guidance. Not only is it important to work with youth to help build their skills, but it is necessary to create and support climates where mediation/conflict resolution is fostered. Implementing restorative justice practices within our schools is one strategy proven to yield success on this front. Mediation and Restorative Justice are philosophies of repairing the harm done by crime by involving the parties affected by the crime. Using Restorative Justice principles, trained staff will facilitate a structured process through which the victim and juvenile offender, and other parties involved (or affected by the offense), sit down together in a safe environment with a neutral, trained facilitator. Through this process, the juvenile is held accountable for the offense, the victim can discuss the impact of the offense, and both parties negotiate together what should be done to repair the harm that was done. Program participation will be voluntary and confidential. Using these models, juveniles are diverted from court, but are still held accountable for their actions. Juveniles need to learn from an early age how to resolve disputes. Frequently, disputes that could be resolved quickly and easily turn into major disagreements because students have never been taught valuable conflict resolution skills and techniques. Youth need to learn in a structured setting how to use techniques to resolve issues in a peaceful, respectful manner. Many times, juveniles are charged with crimes due to the fact that there are few alternative solutions. A diversionary program such as this can assist juveniles after adjudication. There are few resources to address criminal behavior in juveniles prior to adjudication and as a result, many students fail to understand the consequences of their behavior and continue to re -offend. These children continue to experience high rates of school suspensions, create victims within the community, and are repeatedly referred into the criminal justice system. 2. Target Population: Describe the target population, including age, and the steps taken to insure that the target population is served. The target population for the CIS Mediation / Restorative Justice Program is middle and high school students (ages 11 to 18) referred by New Hanover County Schools administrators, school resource officers/law enforcement, or juvenile court counselors. This program is designed to serve youth on diversion plans, or youth that are at -risk, and will accept clients involved in verbal and physical altercations. Youth who are at risk for becoming involved in more serious infractions at school, in the community, or with law enforcement would also benefit from this program. Participants will have the opportunity to work through their dispute in a face-to-face setting with a trained, adult facilitator guiding them through the process. They would then have the opportunity to continue to work with the facilitator either individually, or together as needed. Many of our students live close together and bring neighborhood Form JCPC/PA 001 JCPC Program Agreement Form structure last revised 12/31/2012 Department of Public Safety DocuSign Envelope ID: 9D6D37A6-1DDA-4A15-8E41-C2679ECBF5D6 SECTION III COMPONENT SUMMARY NAME OF COMPONENT: Mediation / Restorative Justice problems into the schools, or vice versa. By creating a program allowing for referrals from the schools and the juvenile system, we aim to divert problems that may continue in the community until they are dealt with and a resolution is found. By utilizing mediation / restorative justice tools, guided by a trained facilitator, participating youth will gain an understanding of what drives their conflict, as well as how to appropriately and safely find resolutions thereto. Parents and families can also benefit from engaging in this work. School administration and the SROs will be involved in student referrals at the school level. When fights take place, the SRO and administration will determine if they are appropriate for referral to mediation / restorative justice intervention. Juvenile court counselors and probation officers would make direct referrals to the mediation program as a means of diversion. This would be a first step, prior to teen court referral, if deemed appropriate for referral, following the School -Justice Partnership Agreement guidelines. 3. Program Goal(s): Provide a brief statement to describe the overall purpose of the program. The overall purpose of the program is to provide youth with life-long conflict resolution skills. We aim to work with youth who have behavior programs, anger issues, and/or poor social skills. If students can learn how to resolve conflicts, referrals to School Resource Officers and Juvenile Court should be lower. This in turn would keep students in school and hopefully keep them on track for graduation from high school. Through Mediation/Restorative Justice practices, students will be given the opportunity to think in a creative manner about how to resolve their conflicts without resorting to name calling, fighting, angry feelings, or even sad feelings because of feeling unable to control their issues. Mediation/Restorative Justice will provide a healthy atmosphere in which students will be guided through a structured process and allowed the opportunity to focus their energy and attention on positively affecting change. The focus becomes one of problem solving rather than getting even or hurting others in some way. The Mediation/Restorative Justice Program would be offered as an alternative prior to a referral to teen court in some situations. The Mediation/Restorative Justice process provides participants with a structured way to settle an issue within the school or community, and the outcomes/resolutions will be the solutions that have been agreed upon by all parties involved. As with most agreements, juveniles usually follow through more readily when they are involved in developing a solution that they feel comfortable with. If students have more control over the outcome, they typically will more readily follow through with the agreed upon resolution plan. Other goals of this program include the following: 1) Provide mediation or restorative justice services to New Hanover County juveniles to reduce the number of criminal complaints sent to the criminal justice system, and to reduce the number of school suspensions. 2) Provide mediation and restorative justice services as a court diversion program. 3) Provide a safe, impartial atmosphere for juveniles to learn how to resolve conflicts. 4) Teach our youth how to address conflicts in peaceful manner. 5) Using interventions early on to resolve conflicts that could escalate into more serious conflict. 4. Measurable Objective(s): State in measurable terms (%) the intended effect of the program on specific undisciplined and/or delinquent behaviors. Example: anticipated reductions in court referrals, runaway behavior, disruptive behavior at school, anticipated improved school attendance and academic achievement. These objectives must include impact on participants. Form JCPC/PA 001 JCPC Program Agreement Form structure last revised 12/31/2012 Department of Public Safety DocuSign Envelope ID: 9D6D37A6-1DDA-4A15-8E41-C2679ECBF5D6 SECTION III I COMPONENT SUMMARY NAME OF COMPONENT: I Mediation / Restorative Justice 70% Clients will have no new complaints with an offense date after the admission date. 70% Clients successfully/satisfactorily completing the program will have no new adjudications in the 12 months following completion. 90% Clients will demonstrate accountability for their actions within the scope of the mediation process. 90% Clients will enter into a mediation agreement. 80% Clients will successfully or satisfactorily complete services as intended by the program design/service plan. 70% Clients successfully/satisfactorily completing the program will have no new complaints in the 12 months following completion. 70% Clients will have no new adjudications for a complaint with an offense date after the admission date. 5. Elevated Risks and Needs: Describe how program services will address one or more of the elevated risk and needs listed in the most recent JCPC Request for Proposal. This program will address behavior problems, poor peer relationships, and youth with aggressive behaviors. Schools, SROs, juvenile court counselors, or probation officers may refer students to mediation for verbal or physical altercations. During the mediation and/or restorative justice sessions, the trained adult facilitator will guide the juvenile offender and victim through a structured process through which they will address the cause of the altercation and work to repair the relationship. By teaching juveniles how to peacefully resolve their issues, we can prevent their conflicts from becoming physical or continuing to cause other disruptive behaviors or feelings. Designed as an option for resolving issues prior to being referred to Teen Court or to Juvenile Court, this program will help to prevent school fights, community problems, and/or behaviors that result in charges of assault, affray and disorderly conduct. Schools and juvenile court staff may use the program as a preventive measure when they realize juveniles are having problems, but before those problems culminate in assaultive or disruptive behavior. The mediation/ restorative justice process provides an opportunity to assist participants in understanding the underlying issues related to their problem, a chance for the offender to take full responsibility, and a chance for the offender and the victim to enter into an agreement which will repair the harm that has already been done. Upon receiving a referral, the participants will be contacted by the program coordinator to schedule a meeting. Participants will initially meet individually with the program coordinator and, if applicable, the CIS Student Support Specialist at their school, in an effort to prepare them for an eventual face to face meeting with the other youth(s) involved. These meetings will take place at a designated office at the participants' school. When the facilitator feels the participants are ready, the face-to-face mediations/restorative justice session(s) will occur. The first part of the session provides an opportunity for the participants to meet and learn more about each other and how they have been harmed during the altercation, etc. Next, the participants will inform each other about why and how the conflict occurred. This allows an opportunity to gain much needed information from each other and to more fully understand what led them to this situation. After this, each participant identifies their losses; and finally, the parties enter into an agreement that spells out what actions will be taken to repair the damage done by the behavior. The mediator/facilitator or the referring agency may determine additional sessions are required for both clients, or individually, and will plan accordingly. If the agreement is fulfilled and the parties are satisfied, the case will be closed and follow up will be provided to ensure the participants continue to honor the agreements that they have agreed to follow. Form JCPC/PA 001 JCPC Program Agreement Form structure last revised 12/31/2012 Department of Public Safety DocuSign Envelope ID: 9D6D37A6-1DDA-4A15-8E41-C2679ECBF5D6 SECTION IV COMPONENT NARRATIVE (attach for each component) NAME OF COMPONENT: Mediation / Restorative Justice 1. Location: List physical address(es) and describe where program services are delivered. Mediations/Restorative Justice activities will take place in an office at the participants' school. Preferably, this space will allow for a conference table where students and the mediator can meet in a quiet, professional location. The space needs to be in an environment free from noise and from the traffic of other activities at the school so that the meetings can remain confidential, and in a safe zone, where students feel comfortable speaking and following through as they attend meetings. If school space is not available, they will take place at the CIS Youth Center, WIRE, 1102 Orange Street, Wilmington, NC 28401. 2. Operation: Describe the daily/weekly schedule of program operation. Mediations / Restorative Justice sessions will be held at the participants' school during the school day, or outside of school hours at the CIS Youth Center, WIRE, 1102 Orange Street, Wilmington, NC 28401. The Teen Court / Restorative Justice Program Coordinator will process referrals, schedule intakes, consult with the referring agencies, and follow up with parents, completing all required NC Allies documentation and any other tasks deemed appropriate. If applicable, they will coordinate with the CIS Student Support Specialist on site at the school to schedule restorative sessions and will provide training for staff as needed, utilizing the assistance of Professor Kim Cook from UNC Wilmington. 3. Staff Positions: Describe paid or volunteer position qualifications, (certifications, degrees, work experience) and position(s) responsibilities relative to this component. The Teen Court / Restorative Justice Program Coordinator will be the trained mediator and will manage this program. They will have at least a bachelor's degree or higher in political science, criminal justice, law, social work, sociology, counseling, or of similar background. The program coordinator will also complete mediation training, and ensure the training is kept current. Additionally, existing CIS school-based staff who are trained in restorative practices may facilitate sessions at their school sites. The successful Teen Court / Restorative Justice Program Coordinator will be self-directed and responsible for making school administrators, school resource officers, and juvenile court staff aware of the opportunities for providing this program. They will have extensive experience working with at -risk youth and families and be willing to go the extra mile as needed in an effort to plan and implement this program. They must be professional in working with youth, parents, and school administrators, as well as SRO's and court staff. They will attend any JCPC required conferences or seminars, as well all DPS required program orientations and trainings, and will document program data in NC Allies as required by all JCPC funded programs. 4. Service Type SPEP: Describe implementation to include: This program is a STRUCTURE ONLY. 5. Admission Process: Describe the specific referral, screening, admission process (including timeline), the staff responsible for making decisions about admissions and reasons why a referral may not be accepted. Referrals will be received from school administrators, school resource officers, juvenile court counselors, or law enforcement officials. This program may be used by juvenile counselors as part of the diversion plans. The program coordinator will receive and process the referral, then schedule the intake sessions at the participant's school. During this intake, all agreements will be signed and materials explaining the program activities and goals will be given to Form JCPC/PA 001 JCPC Program Agreement Form structure last revised 12/31/2012 Department of Public Safety DocuSign Envelope ID: 9D6D37A6-1DDA-4A15-8E41-C2679ECBF5D6 SECTION IV COMPONENT NARRATIVE (attach for each component) NAME OF COMPONENT: Mediation / Restorative Justice youth and parents as needed. All information will be documented in NC Allies. It is extremely important for the program coordinator to meet with the student who is being referred within the week that the referral is received, or at the beginning of the next week if the referral is received at the end of a given week, to ensure timely conflict resolution. Mediation/restorative justice sessions should begin immediately after it is determined that a referral is appropriate - middle and high school youth do not need to wait for several weeks for a conflict to be resolved. The ideal is for all sessions to begin and be completed within a ten-day time period, though support services may continue as needed. This program will provide the flexibility of serving clients on a one-time basis, or by providing additional follow-up sessions as needed. For some cases, the resolution may be resolved and the terminations made after one session. For others, the mediation process may require additional sessions or more activities for completion of the program. 6. Termination Process: Describe the termination process to include the staff responsible for making decisions and the criteria for a successful termination, satisfactory termination, unsuccessful completion and non-compliant termination. Once the mediation/restorative justice sessions have been completed, the program coordinator will follow up with the youth for a minimum of 30 days after termination to ensure the conflict remains resolved, and will include the referring agency in this process. Youth will be allowed to participate in additional sessions if the conflict is not completely resolved, or if the agreement needs to be revisited. The program coordinator and/or session facilitator and the referring agency will determine if one session is adequate for the clients or if additional hours/work needs to be involved. The program coordinator will remain in contact with the referring agency while these needs are assessed. After 90 days, clients will be terminated unless the referral source requests another mediation or unless youth needs additional support/reinforcement of mediation concepts. If the conflict is resolved, the termination will be successful. If the problem continues after several attempts at mediation during the 90 -day period, the termination will be considered unsuccessful. Non-compliant termination would result if there is no progress and the mediation is never completed. How is the referring agency involved with the termination process? The program coordinator will also follow up with the referring agency as needed during this process to find out if the problem has been resolved, and to determine if there are any positive or negative behavior changes. The referring agency will be involved as the plan for the client is developed. Emails and phone calls are considered essential during this process. Weekly follow-up with the referral agency may be needed in some cases. The referring agency will be contacted to determine any additional assistance that is needed in working with clients. 7. Referring Agency Interaction: Describe the interaction with juvenile court counselors and/or other referring agencies including how client progress will be communicated. The program coordinator will be in constant contact with the referral source throughout the intake, enrollment, and mediation/restorative justice process. Additionally, they will communicate weekly with referral sources and participants after the mediation/restorative justice sessions have been completed. The agreement plan will be discussed with the referring source to discuss progress and to determine if the plan has been successfully completed. All parties will be allowed to provide feedback as to whether or not there are additional issues between participants. Communication will be made when the referral is received, after intake, after mediation, and follow up communication during the 30 days. Communication with the referring agency will be critical for feedback to the program coordinator. Form JCPC/PA 001 JCPC Program Agreement Form structure last revised 12/31/2012 Department of Public Safety DocuSign Envelope ID: 9D6D37A6-1DDA-4A15-8E41-C2679ECBF5D6 SECTION IV COMPONENT NARRATIVE (attach for each component) NAME OF COMPONENT: Mediation / Restorative Justice 8. Intervention/Treatment: Describe specifically what the component will do to redirect inappropriate youth behavior or how the component will address the identified needs of the youth and family. What interventions will typically be utilized in this component and how will parents/guardians be involved? Parents will be notified of whether a client is eligible or ineligible to participate in mediation/restorative justice sessions. Parental consent will be required and program sessions and activities will vary depending upon the need of the individual client. Mediation/Conflict resolution sessions, Restorative Justice Circles, and social skill building will be the focus of the program. Some cases may be successfully resolved after the first session. However, the mediator or session facilitator will determine what the plan will consist of, and whether or not additional sessions should be required. If inappropriate behavior is observed during this program, every effort will be made to schedule additional one -to-one meetings with students. Some students may need the additional support in an effort to prepare them for the actual mediation. If a parent does not give consent or if a student refuses to cooperate, they will not participate in the program. During this process other issues could arise indicating the need for other services, such as the services of the school counselor or social worker, or additional mental health supports. If there are needs that indicate immediate danger, the necessary agencies will be contacted. Parent/guardians will be involved as needed. 9. Best Practice Model: Describe what model or evidence-supported/best practice the program is based upon. Evidence -based practices/programs to be implemented within the CIS Mediation/Restorative Justice Program include, but are not limited to, Mediation, Restorative Practices, and the CIS model of integrated student supports. Mediation is a restorative process that provides an opportunity for the victim to meet the offender in a safe space to resolve a conflict assisted by a trained mediator. The models to be used are victim -offender mediation and basic mediation. Using these models, juveniles are diverted from court, but held accountable for their actions. Restorative practices to deal with crime and wrongdoing are recognized as evidence -based practices according to extensive research, which supports that restorative justice is also evidence -based for school discipline. In its 2014 report, the Council of State Governments recommends restorative practices for school discipline, stating that it is evidence -based along with other interventions including Positive Behavioral Interventions and Supports (PBIS). The CIS Model of Integrated Students Supports is supported by research from organizations including Child Trends and the Everyone Graduates Center at Johns Hopkins University. As a student -centered approach, ISS is firmly grounded in the research on child and youth development. Providing an array of academic and non-academic supports in a coordinated manner (as in the CIS Model) is more effective than a focus on one or a few supports. Child Trends concludes that evidence supports the effectiveness and cost-effectiveness of integrated student supports to improve educational outcomes. Form JCPC/PA 001 JCPC Program Agreement Form structure last revised 12/31/2012 Department of Public Safety DocuSign Envelope ID: 9D6D37A6-1DDA-4A15-8E41-C2679ECBF5D6 SECTION V Terms of Agreement This Agreement is entered into by and between Department of Public Safety (hereinafter referred to as DPS), and New Hanover County, (hereinafter referred to as the County), the County's Juvenile Crime Prevention Council (hereinafter referred to as the JCPC) and Communities In Schools of Cape Fear (hereinafter referred to as the Sponsoring Agency). DPS, the County, the JCPC and the Sponsoring Agency do mutually agree as follows: Term of Agreement This Agreement shall become effective Jul 1, 2022 and shall terminate Jun 30, 2023. Payment to Sponsoring Agency All parties agree that services will be delivered as described in the approved Program Agreement and that funds will be disbursed in an amount not to exceed the amount $92345 for the term of this agreement, unless amended by an approved Program Agreement Revision. Availability of Funds: All parties to this Agreement agree and understand that the payment of the sums specified in this Program Agreement budget, or most recently approved Program Agreement Revision, is dependent and contingent upon and subject to the appropriation, allocation, and availability of funds for this purpose to DPS. Responsibilities of the Parties DPS shall: 1. Disburse funds monthly to County Governments, for payment to the Sponsoring Agency, from funds appropriated by the General Assembly; 2. Reserve the right to suspend payment to the County for any non-compliance of reporting requirements by the Sponsoring Agency set forth in the DPS JCPC Policy; 3. Immediately notify, in writing, the JCPC, County, and Sponsoring Agency (including the Board of Directors, if applicable), if payments are suspended and again once payments resume; 4. Pay only for work as described in the Program Agreement, or most recently approved Program Agreement Revision, provided by the Sponsoring Agency and approved subcontractors; 5. Provide technical assistance, orientation, and training to the Sponsoring Agency, the County and the JCPC; 6. Monitor the Sponsoring Agency's funded program(s) in accordance with DPS JCPC Policy 3. Operations: Program Oversight and Monitoring; and Form structure last revised 12/20/2013 Department of Public Safety DocuSign Envelope ID: 9D6D37A6-1 DDA-4A15-8E41-C2679ECBF5D6 7. Notify parties entering into this Agreement of all due dates in a timely manner in order for reports to be submitted by the established due dates. The Sponsoring Agency shall: 1. Comply with all laws, ordinances, codes, rules, regulations, and licensing requirements that are applicable to the conduct of its business, including those of Federal, State, and local agencies having jurisdiction and/or authority; 2. Comply with all Federal and State laws relating to equal employment opportunity; 3. Keep as confidential and not divulge or make available to any individual or organization without the prior written approval of DPS any information, data, instruments, documents, studies or reports given to or prepared or assembled by the Sponsoring Agency under this Agreement; 4. Acknowledge that in receiving, storing, processing or otherwise dealing with any confidential information, it will safeguard and not redisclose the information, except as otherwise provided in this Agreement; 5. Comply with the DPS JCPC Policy and North Carolina Administrative Code procedures; 6. Secure local match, if applicable, pursuant to 14B NCAC 11 B.0105, for the approved DPS funds; 7. Create and adopt individualized written agency guidelines specific to the funded program, while also adhering to DPS JCPC Policy for the specific funded program type; 8. Ensure that state funds received are spent in accordance with the approved Program Agreement, or most recently approved Program Agreement Revision, and be accountable for the legal and appropriate expenditure of those state funds; 9. Maintain reports, records, and other information to properly document services rendered and outcomes; also maintain an ability to send and receive electronic communication; 10. Have the capacity to use the DPS electronic, internet-based system for tracking clients served; also maintain an ability to electronically sign required DPS documents; 11. Use generally accepted accounting procedures that guarantee the integrity of the expenditure of funds, and maintain reports, records, and other information to properly account for the expenditure of all State funds provided to the Sponsoring Agency; 12. When refunds are requested from the North Carolina Department of Revenue for sales and/or use taxes paid by the agency in the performance of the Program Agreement, or most recently approved Program Agreement Revision, as allowed by NCGS § 105-164.14(c), the agency shall exclude all refundable sales and use taxes from reportable expenditures submitted to the County and DPS; 13. Submit Program Agreement Revisions, Third Quarter Accounting, Final Accounting, and annual detailed expenditures through NCALLIES. These reports must be in accordance with the submission process as outlined in the DPS JCPC Policy and with the due dates established by DPS; 14. Make personnel, reports, records and other information available to DPS, the County, the JCPC, and/or the State Form structure last revised 12/20/2013 Department of Public Safety DocuSign Envelope ID: 9D6D37A6-1DDA-4A15-8E41-C2679ECBF5D6 Auditor for oversight, monitoring and evaluation purposes; 15. Submit any other information requested by DPS, the County, the JCPC, and/or the State Auditor; 16. Be responsible for the performance of all subcontractors as described in the Program Agreement or most recently approved Program Agreement Revision; 17. Indemnify, defend, and hold harmless DPS, the State of North Carolina, the County, the JCPC and any of their officers, agents and employees, from any claims of third parties arising out of any act or omission of the Sponsoring Agency in connection with the performance of the Program Agreement or most recently approved Program Agreement Revision; 18. Receive written permission and budgetary approval from DPS prior to using the Program Agreement, or most recently approved Program Agreement Revision, as a part of any news release or commercial advertising, and acknowledge DPS funding in partnership with the County; 19. Comply with DPS JCPC Policy 6: Operations: Program Eligibility for Funding regarding any trainings and requirements for the United States Department of Justice national standards to prevent, detect, and respond to prison rape under the Prison Rape Elimination Act (PREA) and any additional requirements in 14B NCAC 11 C 20. Be deemed an independent contractor in the performance of services described in the Program Agreement, or most recently approved Program Agreement Revision, and as such shall be wholly responsible for the services to be performed and for the supervision of its employees, interns, volunteers and subcontractors; and 21. Represent that it has, or shall secure at its own expense, all personnel required in performing the services as described in the Program Agreement, or most recently approved Program Agreement Revision. Such personnel shall not be employees of or have any individual contractual relationship with DPS. Sponsoring Agency and Use of Contractor(s)/Subcontractors The Sponsoring Agency may engage with independent contractors as needed to perform services or support services described in line item 190 the Program Agreement, or most recently approved Program Agreement Revision. When independent contractors are providing services the Sponsoring Agency must: 22. Upload a signed Contract for Professional Services (Form JCPC/PO 001 Contract for Professional Services Template) into NCALLIES once the Program Agreement or Program Agreement Revision is approved by DPS; 23. Be responsible for the performance of all contractors or subcontractors as described in the Program Agreement, or most recently approved Program Agreement Revision; 24. Hold any contractor or subcontractor to which the Sponsoring Agency provides State funds accountable for the legal and appropriate expenditure of State funds and require compliance with all applicable laws and DPS JCPC Policy; and 25. Ensure that all contractors or subcontractors provide all information necessary to comply with the standards set forth in the Program Agreement, or most recently approved Program Agreement Revision. The JCPC shall: Form structure last revised 12/20/2013 Department of Public Safety DocuSign Envelope ID: 9D6D37A6-1DDA-4A15-8E41-C2679ECBF5D6 1. Ensure the Sponsoring Agency uses JCPC funds only for the purposes approved by DPS in the JCPC Program Agreement or most recently approved JCPC Program Agreement Revision; 2. Comply with the DPS JCPC Policy, the North Carolina Administrative Code procedures (14B NCAC 11 B), and N.C. G.S. §§ 14313-845 to 851; 3. Review and locally approve Program Agreements, Program Agreement Revision(s), and Third Quarter Accounting and submit information to the County in a timely manner to meet due dates established by DPS; 4. Submit any other information requested by the County or DPS; and 5. Monitor the Sponsoring Agency's currently funded JCPC program(s) in accordance with DPS JCPC Policy 3. Operations: Program Oversight and Monitoring. Reference: 14B NCAC 118.0202 and DPS JCPC Policy (policies 1, 3, 7, 8, 9, 10 and 11). The County shall: 1. Ensure the Sponsoring Agency is appropriately licensed when applicable, and either a local public agency, a 501(c) 3 nonprofit corporation or local housing authority (applicable only to the JCPC funding process); 2. Use funds only for the purposes approved by DPS in the Program Agreement, or most recently approved Program Agreement Revision; 3. Disburse funds monthly and oversee funds to the Sponsoring Agency in accordance with 14B NCAC 11 B.0108; 4. Comply with the DPS JCPC Policy and North Carolina Administrative Code procedures (14B NCAC 11 B); 5. Review and locally approve Program Agreement Revisions received from the Sponsoring Agency for final approval from DPS; and 6. Review and locally approve Third Quarter and Final Accounting forms for the JCPC and all funded programs according to the procedures and due dates established by DPS. Reference: 14B NCAC 11 B.0108; DPS JCPC Policy (policies 8 and 9). Headings: The Section and Paragraph headings in these General Terms and Conditions are not material parts of the agreement and should not be used to construe the meaning thereof. Choice of Law: The validity of this Program Agreement and any of its terms or provisions, as well as the rights and duties of the parties to this Program Agreement, are governed by the laws of North Carolina, including the relevant provisions of G.S. Chapter 143B, Article 13, Part 3, Subpart F, and the Rules of 14B NCAC Chapter 11. The parties, by signing this Program Agreement, agree and submit, solely for matters concerning this Program Agreement, to the exclusive jurisdiction of the courts of North Carolina and agree, solely for such purpose, that the exclusive venue for any legal proceedings shall be Wake County, North Carolina. The place of this Program Agreement and all Form structure last revised 12/20/2013 Department of Public Safety DocuSign Envelope ID: 9D6D37A6-1DDA-4A15-8E41-C2679ECBF5D6 transactions and agreements relating to it, and their situs and forum, shall be Wake County, North Carolina, where all matters, whether sounding in Program Agreement or tort, relating to the validity, construction, interpretation, and enforcement shall be determined. Assignment: No assignment of the Sponsoring Agency's obligations or the Sponsoring Agency's right to receive payment hereunder shall be permitted. However, upon written request approved by the issuing purchasing authority, DPS may: (a) Forward the Sponsoring Agency's payment check(s) directly to any person or entity designated by the Program Manager, or (b) Include any person or entity designated by the Sponsoring Agency as a joint payee on the Sponsoring Agency's payment check(s). In no event shall such approval and action obligate DPS or County Government to anyone other than the Sponsoring Agency, and the Sponsoring Agency shall remain responsible for fulfillment of all Program Agreement, or the most recently approved Program Agreement Revision, obligations. Beneficiaries: Except as herein specifically provided otherwise, this Program Agreement shall inure to the benefit of and be binding upon the parties hereto and their respective successors. It is expressly understood and agreed that the enforcement of the terms and conditions of this Program Agreement, and all rights of action relating to such enforcement, shall be strictly reserved to DPS, the County Government, and the Sponsoring Agency. Nothing contained in this document shall give or allow any claim or right of action whatsoever by any third person. It is the express intention of DPS and County Government that any such person or entity, other than DPS or the County Government or the Sponsoring Agency receiving services or benefits under this Program Agreement shall be deemed an incidental beneficiary only. Property Rights Intellectual Property: All deliverable items produced pursuant to this Program Agreement are the exclusive property of DPS. The Sponsoring Agency shall not assert a claim of copyright or other property interest in such deliverables. Physical Property The Sponsoring Agency agrees that it shall be responsible for the proper custody and care of any property purchased for or furnished to it for use in connection with the performance of this Program Agreement, or the most recently approved Program Agreement Revision, and will reimburse DPS for loss of, or damage to, such property. At the termination of this Program Agreement, the Sponsoring Agency, County Government, and JCPC shall follow the guidelines for disposition of property set forth in the North Carolina Administrative Code and DPS JCPC Policy 1. Operations: JCPC Operations. Reference: 14B NCAC 118.0110. Disbursements and Internal Controls Reversion of Unexpended Funds Any remaining unexpended funds disbursed by DPS to the County for the Sponsoring Agency must be refunded/ reverted back to DPS at the close of the fiscal year or upon termination of this Agreement. Form structure last revised 12/20/2013 Department of Public Safety DocuSign Envelope ID: 9D6D37A6-1DDA-4A15-8E41-C2679ECBF5D6 Accountability for Funds Audit Requirement - Local Government or Public Authority Requirements Local Government or Public Authorities in accordance with N.C.G.S. § 159-34 must have an audit performed in conformity with generally accepted auditing standards. The audit shall evaluate the performance of a unit of local government or public authority regarding compliance with all applicable Federal and State agency regulations. This audit, combined with the audit of financial accounts, shall be deemed to be the single audit described by the "Federal Single Audit Act of 1984". Audit Requirement — Non -Governmental Entities An audit, when required by law, or requested by the County or DPS shall be performed in conformity with generally accepted auditing standards and audits of non-governmental entities, both for-profit and not-for-profit, and must meet the requirements of OMB Circular A-133. At a minimum, the required report shall include the financial statements prepared in accordance with generally accepted accounting principles, all disclosures in the public interest required by law, and the auditor's opinion and comments relating to financial statements. The audit report must be submitted to the State Auditor's office as required by law, to the County, and DPS, and to other recipients as appropriate within nine (9) months after the end of the program's fiscal year. Oversight Access to Persons and Records The State Auditor shall have access to persons and records related to all Program Agreements entered into by State agencies or political subdivisions in accordance with N.C.G.S. § 147-64.7. Additionally, as the State funding authority, DPS shall have access to persons and records related to all Program Agreements entered into by State agencies or political subdivisions. Record Retention Records shall not be destroyed, purged, or disposed of without the express written consent of DPS. State basic records retention policy requires all records to be retained for a minimum of five (5) years or until all audit exceptions have been resolved, whichever is longer. If the Program Agreement is subject to Federal policy and regulations, record retention may be longer than five (5) years since records must be retained for a period of three (3) years following submission of the final Federal Financial Status Report, if applicable, or three (3) years following the submission of a revised final Federal Financial Status Report. Also, if any litigation, claim, negotiation, audit, disallowance action, or other action involving this Program Agreement has been started before expiration of the five- year retention period described above, the records must be retained until completion of the action and resolution of all issues which arise from it, or until the end of the regular five-year period described above, whichever is later. No Overdue Tax Debt Not for profit organizations ONLY must comply with this section. This form must be uploaded in NCALLIES when submitting a Program Agreement. The Sponsoring Agency shall be responsible for the payment of all State, local, and Federal taxes. Consistent with N. C.G.S. § 143C -6-23(c), not for profit organizations shall file with DPS and the County a written statement completed by that Sponsoring Agency's Board of Directors or other governing body, stating whether or not the Sponsoring Agency has any overdue tax debts, as defined by N.C.G.S. § 105-243.1, at the Federal, State, or local level. This written statement, No Overdue Tax Debts, shall be completed by the Sponsoring Agency to certify when there are no overdue taxes. If the agency has overdue taxes, the Sponsoring Agency must notify DPS at the time a Program Agreement is submitted. Form structure last revised 12/20/2013 Department of Public Safety DocuSign Envelope ID: 9D6D37A6-1 DDA-4A15-8E41-C2679ECBF5D6 Conflict of Interest Not for profit organizations ONLY must comply with this section. This form must be uploaded in NCALLIES when submitting a Program Agreement. Consistent with the N.C.G.S. § 143C -6-23(b), not for profit organizations shall file with DPS and the County, a copy of that Sponsoring Agency's policy addressing conflicts of interest that may arise involving the Sponsoring Agency's management employees and the members of its Board of Directors or other governing body. The policy shall address situations in which any of these individuals may directly or indirectly benefit, except as the Sponsoring Agency's employees or members of its Board or other governing body, from the Sponsoring Agency's disbursing of State funds and shall include actions to be taken by the Sponsoring Agency or the individual, or both to avoid conflicts of interest and the appearance of impropriety. The policy shall be filed before the County or DPS will disburse any funds. The Sponsoring Agency shall also complete the DPS Conflict of Interest Policy Statement (Form DPS 13 001) and upload the statement in NCALLIES along with and the Sponsoring Agency's policy addressing conflicts of interests. Proof of 501(c)(3) Not for profit organizations ONLY must comply with this section. This form must be uploaded in NCALLIES when submitting a Program Agreement. Not for profit organizations must upload proof of the agency's 501(c)(3) status when submitting a program agreement in NCALLIES. Amendment: This Agreement may not be amended orally or by performance. Any amendment must be requested by the Sponsoring Agency through submission of a Program Agreement Revision and executed by duly authorized representatives of DPS, the County Government, JCPC, and Sponsoring Agency. Severability: In the event that a court of competent jurisdiction holds that a provision or requirement of this Program Agreement violates any applicable law, each such provision or requirement shall continue to be enforced to the extent it is not in violation of law or is not otherwise unenforceable and all other provisions and requirements of this Program Agreement shall remain in full force and effect. Termination for Cause: If, through any cause, the Sponsoring Agency shall fail to fulfill its obligations under this Program Agreement in a timely and proper manner, DPS shall have the right to terminate this Program Agreement by giving written notice to the Sponsoring Agency and specifying the effective date thereof. In that event, all finished or unfinished deliverable items prepared by the Sponsoring Agency under this Program Agreement shall, at the option of DPS, become its property and the Sponsoring Agency shall be entitled to receive just and equitable compensation for any satisfactory work completed on such materials, minus any payment or compensation previously made. Notwithstanding the foregoing provision, the Sponsoring Agency shall not be relieved of liability to DPS for damages sustained by DPS by virtue of the Sponsoring Agency's breach of this agreement, and DPS may withhold any payment due the Sponsoring Agency for the purpose of setoff until such time as the exact amount of damages due DPS from such breach can be determined. The filing of a petition for bankruptcy by the Sponsoring Agency shall be an act of default under this Program Agreement. Termination without Cause: DPS, the County Government, or the Sponsoring Agency may terminate this Agreement at any time and without cause by giving at least thirty (30) days advance written notice to the other parties. If this Program Agreement is terminated by DPS as provided herein, the Sponsoring Agency shall be reimbursed on a pro rata basis for services satisfactorily provided to DPS under this Program Agreement, or the most recently approved Program Agreement Revision, prior to Program Agreement termination. Waiver of Default: Waiver by DPS of any default or breach in compliance with the terms of this Program Agreement, or the most recently approved Program Agreement Revision, by the Sponsoring Agency shall not be deemed a waiver of any subsequent default or breach and shall not be construed to be modification of the terms of this Program Agreement unless stated to be such in writing, signed by an authorized representative of DPS, County Government, Form structure last revised 12/20/2013 Department of Public Safety DocuSign Envelope ID: 9D6D37A6-1DDA-4A15-8E41-C2679ECBF5D6 the JCPC, and the Sponsoring Agency. Force Majeure: Neither party shall be deemed to be in default of its obligations hereunder if and so long as it is prevented from performing such obligations as a result of events beyond its reasonable control, including, without limitation, fire, power failures, any act of war, hostile foreign action, nuclear explosion, riot, strikes, civil insurrection, earthquake, hurricane, tornado, or other catastrophic natural event, pandemic, or act of God. Survival of Promises: All promises, requirements, terms, conditions, provisions, representations, guarantees, and warranties contained herein shall survive the Program Agreement expiration or termination date unless specifically provided otherwise herein, or unless superseded by applicable Federal or State statutes of limitation. Entire Agreement: This Program Agreement (including any documents mutually incorporated specifically herein) represents the entire agreement between the parties and supersedes all prior oral or written statements or agreements. END OF SECTION V — Terms of Agreement Form structure last revised 12/20/2013 Department of Public Safety DocuSign Envelope ID: 9D6D37A6-1 DDA-4A15-8E41-C2679ECBF5D6 SECTION VI: BUDGET NARRATIVE Teen Court & Mediation (Restorative Justice) Fiscal Year FY 22-23 $40,000 Teen Court / Restorative Justice volunteers Item # Justification Expense In Kind Expense 120 Administrative support - payroll / accounts payable & receivable - 2 hours per week; $21 per hour $2,184 120 Program Director - Project Management and oversight; .15 FTE $7,200 TOTAL 120 Value of in-kind volunteers (teens @ 8/hour; professionals / adults @ $23.07/hour) $20,000 120 Teen Court / Restorative Justice Assistant; 20 hours per week; $17 per hour $17,680 120 Teen Court / Restorative Justice Program Coordinator; 1 FTE $40,000 180 Pro -rated Medical Benefits @ $288.75 per month $3,465 180 FICA @.0765%; Worker's Comp @.0168%; SUI @.0084% $6,820 220 Food/Refreshments as needed for teen court nights, training, special teen court functions, and end of year activities $3,000 260 Consumable office supples (paper, ink, misc. supplies) $3,000 290 Student materials for Teen Court sessions estimated @ $30 per month x 12 months $360 310 Local mileage, travel & / training for all project staff and volunteers, and some school staff $6,036 320 Phone, internet $500 390 Deputy for court 20 nights x $40 = $800; Teen Court Assistants �(2) for 20 nights x 90 = 1800; $2,600 TOTAL $92,345 $20,500 Job Title Annual Expense Wages Annual In Kind Wages Teen Court / Restorative Justice Program Coordinator $40,000 Teen Court / Restorative Justice volunteers $20,000 Administrative Support - payroll / accounts payable & receivable $2,184 Teen Court / Restorative Justice Program Assistant $17,680 Program Director $7,200 TOTAL $67,064 $20,000 Form JCPC/PA 001 JCPC Program Agreement Form structure last revised 12/31/2012 Department of Public Safety DocuSign Envelope ID: 9D6D37A6-1DDA-4A15-8E41-C2679ECBF5D6 SECTION VII Program: Teen Court & Mediation (Restorative Justice) Fiscal Year: FY 22-23 $0 Number of Months: 12 $0 430 Equipment Rental Cash In Kind Total I. Personnel Services $77,349 $20,000 $97,349 120 Salaries & Wages $67,064 $20,000 $87,064 180 Fringe Benefits $10,285 $10,285 190 Professional Services" $0 *Contracts MUST be attached II. Supplies & Materials $6,360 $6,360 210 Household & Cleaning $0 220 Food & Provisions $3,000 $3,000 230 Education & Medical $0 240 Construction & Repair $0 250 Vehicle Supplies & Materials $0 260 Office Supplies and Materials $3,000 $3,000 280 Heating & Utility Supplies $0 290 Other Supplies and Materials $360 $360 III. Current Obligations & Services $8,636 $500 $9,136 310 Travel & Transportation $6,036 $6,036 320 Communications $500 $500 330 Utilities $0 340 Printing & Binding $0 350 Repairs & Maintenance $0 370 Advertising $0 380 Data Processing $0 390 Other Services $2,600 $2,600 IV. Fixed Charges & Other Expenses $0 410 Rental or Real Property $0 430 Equipment Rental $0 440 Service and Maint. Contracts $0 450 Insurance & Bonding $0 490 Other Fixed Charges $0 V. Capital Outlay $0 [This Section Requires Cash Match] 510 Office Furniture & Equipment $0 530 Educational Equipment $0 540 Motor Vehicle $0 550 Other Equipment $0 580 Buildings, Structure & Improv. $0 Total $92,345 $20,500 $112,845 Form JCPC/PA 001 JCPC Program Agreement Form structure last revised 12/31/2012 Department of Public Safety DocuSign Envelope ID: 9D6D37A6-1DDA-4A15-8E41-C2679ECBF5D6 SECTION VIII SOURCES OF PROGRAM REVENUE (ALL SOURCES) FY 22-23 New Hanover County Funding ID: 865-XXXX Sponsoring Agency: Communities In Schools of Cape Fear Program: Teen Court & Mediation (Restorative Justice) $92,345 DPS/JCPC Funds * This is the amount approved in your application 20% Local Match Rate Is the Local Match Rate 10%, 20% or 30%? County Cash (Specify Source) Local Cash (Specify Source) Local Cash (Specify Source) $20,500 Local In -Kind Volunteers; CIS Cape Fear (Specify Source) Other (Specify Source) Other (Specify Source) Other (Specify Source) Other (Specify Source) $112,845 TOTAL $18,469 $20,500 Required Local Match Match Provided cuSigned by:�E7A4BD9F419... Ei:', 6�3�2�22 Authorizing Official, Department of Public Safety Date Thefollowing signature certifies that this program agreement has been locally approved by the Board of County Commissioners. DocuSigned by: //'' 11 ��L�_ f , ,V�OtI'1 (6 IvxI f � " O' 5/31/2022 9507FA3F06164E9... Chair, County Board of Commissioners or County Finance Director Date The following signature certifies that this program agreement has been locally approved by the Juvenile Crime Prevention Council. DocuSigned by: (� covpuu" if 5/26/2022 3DDSE15D4A2540C... Chair, Juvenile Crime Prevention Council Date by: EDocuSigned 0 -01st f Wc�s 5/25/2022 3D778065587B45F... Program Manager Date Form JCPC/PA 001 JCPC Program Agreement Form structure last revised 12/31/2012 Department of Public Safety DocuSign Envelope ID: 9D6D37A6-1DDA-4A15-8E41-C2679ECBF5D6 INTERNAL REVFMF SERVICE P. O. BOX 2568 CINCINNATI, OH 45201 Date! MAY 10 2006 CCAM[]NITIES IN SCHOOLS OF CAPE FEAR INC 2015 S 17TH ST WILMINGTON, NC 28401 Dear Applicant: DEPARTMENT OF THE TREASURY Employer Identification Number: 20-3385755 DLN: 17053086020016 Contact Person: NANCY L HEAGNEY IN 31306 Contact Telephone Number.. (877) 829-5500 Accounting Period Ending: June 30 Public Charity Status: 17C (b) (1) (A) (vi) Form 990 Required; Yes Effective Bate of Exemption: June 1, 2005 Contribution Deductibility: Yes Advance Ruling Ending Date: ,lune 30, 2009 We are pleased to inform you that upon review of your application for tax exempt status we have determined that you are exempt from Federal ipcome tax under section 501(c)(3) of the Internal Revenue Code. Contributions to you are deductible under section 170 of the Code. You are also qualified to receive tax deductible bequests, devises, transfers or gifts under section 2055, 2146 or 2522 of the Code. Because this letter could help resolve any questions regarding your exempt status, you should keep it, in your permanent records. Organizations exempt under section 501(c)(3) of the Code are further classified as either public charities or private foundations. During your advance ruling period, you will be treated as a public charity. Your advance ruling period begins with the effective date of your exemption and ends with advance ruling ending date shown in the heading of the letter. Shortly before the end of your advance ruling period, we will send you Form 8734, Support Schedule for Advance Ruling Period. You will have 90 days after the end of your advance ruling period to return the completed form. We will then notify you, in writing, about your public charity status. Please see enclosed Information for Exempt Organizations Under Section Sol(c)0) for some helpful information about your responsibilities as an exempt organization.. Letter 1045 (DO/CG) DocuSign Envelope ID: 9D6D37A6-1DDA-4A15-8E41-C2679ECBF5D6 SLATE NC DEPARTMENT OF PUBLIC SAFETY NOT FOR PROFIT ''►�` DPS CONFLICT OF INTEREST POLICY STATEMENT This document is only required from not for profit organizations ONLY: In accordance with the N.C.G.S 143C-6-23 (b), every Grantee shall file with the State agency/Grantor a copy of the Grantee's agency policy addressing conflicts of interest that may arise involving the Grantee's management employees and the members of its board of directors or other governing body. The policy shall address situations in which any of these individuals may directly or indirectly benefit, except as the Grantee's employees or members of its board or other governing body, from the Grantee's disbursing of State funds and shall include actions to be taken by the Grantee or the individual, or both to avoid conflicts of interest and the appearance of impropriety. Agency conflict of interest policy shall be submitted to the Department of Public Safety (DPS) to avoid any delay with the disbursement of DPS JCPC funds. The Grantee shall submit this form (Not for Profit DPS Conflict of Interest Policy Statement Form DPS 13 00 1) along with the agency's conflict of interest policy when applyingfor funding. Accordingly, no member or board member of the private, nonprofit entity may receive directly or indirectly, any funds received from the State of North Carolina, except for duly, authorized staff compensation and benefits, and reimbursement for expenses actually incurred in connection with the private, nonprofit entity's business and in accordance with final approved grant agreements. WHEREAS, Communities In Schools of Cape Fear desires to require its Board of Directors and managing employees to avoid conflicts of interest or the appearance of impropriety in the disbursement of State funds; THEREFORE, no member of the Board of Directors or staff members of said private, nonprofit entity shall participate in the solicitation, negotiation, formation, award, arbitration, modification, or settlement of any contract or grant funded in whole or in part by State funds or of any dispute arising under such contract or grant when the director or staff members stands to benefit, either directly or indirectly, from such grant or contract; PROVIDED, no member of the Board of Directors or staff members shall be deemed to benefit directly or indirectly from any contract or grant funded in whole or in part by State funds if he/she receives only the salary or stipend due to him/her in the normal course of employment with, or service to, said private, nonprofit entity. FURTHERMORE, said private, nonprofit entity has written conflict of interest policies and reporting procedures applicable to board members, staff members and volunteers who have any interest or any authority regarding the resources of the private, nonprofit entity. These policies have been communicated to board members, staff members and volunteers and full disclosure has been provided for any possible appearance of conflict of interest that may exist. Form DPS 13 001 Not for Profit DPS Conflict of Interest Policy Statement Form structure last revised July 2014 NC Department of Public Safety Page 1 of 3 DocuSign Envelope ID: 9D6D37A6-1DDA-4A15-8E41-C2679ECBF5D6 6£ omoppl— NC DEPARTMENT OF PUBLIC SAFETY NOT FOR PROFIT W DPS CONFLICT OF INTEREST POLICY STATEMENT The following serves to identify and document any personal interest staff members, officers, and members of the Board of Directors may have. This document is also to be used to disclose any transactions that may result in personal, financial, professional and/or political gain at the expense of DPS. The statement requires that all personal relationships that may inappropriately influence (bias) actions be disclosed. Relationships, be it personal, financial, professional and/or political are required to be disclosed to DPS Conflict means a conflict or the appearance of a conflict between the private interests and official responsibilities of a person in a position of trust. Persons in a position of trust include staff members or the Board of Directors. Private, nonprofit entities shall make full disclosure by notice in writing to the full Governing Board/Council all conflicts of interest, if "yes" is answered to any of the following: (Check all that apply) Form DPS 13 001 Not for Profit DPS Conflict of Interest Policy Statement Form structure last revised July 2014 NC Department of Public Safety Page 2 of 3 YES NO 1. A Board member is related to a staff member. ❑ X 2. A staff member in a supervisory capacity is related to another staff ❑ X member whom he/she supervises. 3. A staff member is related to another staff member. ❑ X 4. A board member or staff member has or may have personal, ❑ X financial, professional, and/or political gain at the expense or benefit of the private, nonprofit entity. 5. There is a business entity in which a staff, board, or family member ❑ X participates that may be viewed as having direct or indirect influence over the private, nonprofit entity's business. 6. A staff, board, or family member may be viewed as having direct ❑ X or indirect financial gain from personal or business investments/interest in real property held by that staff, board, or family member. 7. A staff or board member received honorarium or other ❑ X compensation outside of the scope of employment/operations with the private, nonprofit entity that creates or appears to create bias. 8. A staff or board member secured employment with a competitor or ❑ X other similar private, non rotit entity. 9. Ongoing, paid consulting work outside of the staff member's ❑ X current employment or board member's with your private, nonprofit entity exists. Form DPS 13 001 Not for Profit DPS Conflict of Interest Policy Statement Form structure last revised July 2014 NC Department of Public Safety Page 2 of 3 DocuSign Envelope ID: 9D6D37A6-1DDA-4A15-8E41-C2679ECBF5D6 d wSU�ON� ;NC DEPARTMENT OF PUBLIC SAFETY NOT FOR PROFIT DPS CONFLICT OF INTEREST POLICY STATEMENT 1. If "yes" is checked to any of the aforementioned items, the JCPC Program Manager and Board Chair must ensure details for any transaction that exists are described and attached to this form. 2. If this statement fails to list a transaction that may exist that is non-financial in nature, please attach details. 3. Details must include at least the name, and, address, or persons involved, and a description of the relationship and the transaction. Note: Failure to disclose any conflict of interest transaction that exists or is potential within your private, nonprofit entity may result in the cessation of any further DPS JCPC State funds. County: New Hanover Agency's Name: (Legal Applicant) Communities In Schools of Cape Fear Federal Tax ID #: 20-3385755 Private, Nonprofit Entity Name: Executive Director's Print Name: Sign Communities In Schools of Cape Fear Louise Hicks Board Chair's Print Jim Busby Name: Sign Sworn to and subscribed before me on the Day of the date of said certification eC4 (Date of Signature) Form DPS 13 001 Not for Profit DPS Conflict of Interest Policy Statement Folin structure last revised July 2014 NC Department of Public Safety Page 3 of 3 DocuSign Envelope ID: 9D6D37A6-1DDA-4A15-8E41-C2679ECBF5D6 A ,,a06�, Communities In Schools Gape Fear May 23, 2022 To: State Agency Head and Chief Fiscal Officer Certification: I certify that Communities In Schools of Cape Fear does not have any overdue tax debts, as defined by N.C.G.S. 105-243.1, at the federal, State, or local level. We further understand that any person who makes a false statement in violation of N.C.G.S. 143C -6-23(c) is guilty of a criminal offense punishable as provided by N.C.G.S. 143-34(b). Sworn Statement: Jim Busby and Evan Renneker, being duty sworn, says that they are the Board Chair and Treasurer, respectively, of Communities In Schools of Cape Fear of Wilmington in the State of North Carolina; and that the foregoing certification is true, accurate and complete to the best of their knowledge and was made and subscribed by me. I also acknowledge and understand that any misuse of State funds will be reported to the appropriate authorities for further action. 01%1111 f f f f f/ ON Jim6gusby, Board Chair �2 O 11 � y R i Evan Reny► ker, T asurer W Y0 QJ N [� % 'gyp 'A % 1�1�'" " 'N Y e'v County, North Carolina // NI `�>> Sworn to and subscribed before me on the day of the date of said certification. NAV signatur4nd Seal My Commission Expires Communities In Schools of Cape Fear, PO Box 398, Wilmington, N.C. 28402 910-343-1901; 910-343-8566 (fax); www.ciscapefear.org DocuSign Envelope ID: 9D6D37A6-1DDA-4A15-8E41-C2679ECBF5D6 Communities In Schools Cape Fear BOARD OF DIRECTORS CONFLICT OF INTEREST POLICY In accordance with GS 143-6.1 and related legislation, we, the undersigned entity, have adopted the following policy regarding conflicts of interest: The undersigned entity is aware that in the process of fund allocation by its management, members of the board of directors, or other governing body, instances may arise which have the appearance of impropriety. In order to avoid conflicts of interest or the appearance of impropriety, should instance arise where a conflict may be perceived, any individual who may benefit, directly or indirectly, from the entity's disbursement of funds shall abstain from participating in any decisions or deliberation by the entity regarding the disbursement of the funds. • The undersigned entity recognizes the possibility that it may be the recipient of funds which are allocated consistent with the purpose and goals of its programs. If such allocations are made, the undersigned entity will strive to ensure that funds are expended in such a manner that no individual will benefit, directly or indirectly, from the expenditure of such funds in a manner inconsistent with its programs. Board Member Signature / DATE Printed Name Communities In Schools of Cape Fear, PO Box 398, Wilmington, N.C. 28402 910-343-1901; 910-343-8566 (fax); www.ciscapefear.org DocuSign Certificate Of Completion Envelope Id: 9D6D37A61DDA4A158E41C2679ECBF5D6 Status: Completed Subject: DPS eSignature Request for New Hanover 865-23641 Teen Court & Mediation (Restorative Justice) Source Envelope: Document Pages: 35 Signatures: 4 Envelope Originator: Certificate Pages: 5 Initials: 0 DPS-DJJ Community Programs AutoNav: Enabled 3040 Hammond Business PI Envelopeld Stamping: Enabled Raleigh, NC 27603 Time Zone: (UTC -05:00) Eastern Time (US & Canada) djjdp.applicationsupport@ncdps.gov IP Address: 207.4.107.7 Record Tracking Status: Original Holder: DPS-DJJ Community Programs Location: DocuSign 5/25/2022 7:16:26 PM djjdp.applicationsupport@ncdps.gov Signer Events Signature Timestamp DocuSigned by LOUISE E HICKSI Sent: 5/25/2022 7:16:28 PM Louise@ciscapefear.org 0ulsf -E K� s Viewed: 5/25/2022 8:41:33 PM Executive Director lb3D778065587B4,5F_ Signed: 5/25/2022 8:41:53 PM Security Level: Email, Account Authentication (None) Signature Adoption: Pre -selected Style Signed by link sent to Louise@ciscapefear.org Using IP Address: 107.12.48.62 Electronic Record and Signature Disclosure: Accepted: 6/4/2020 3:49:54 PM ID:62e44c5f-6edb-4650-bOc5-dc41ab71686a J H Corpening II by: Sent: 5/25/2022 8:41:55 PM julius.h.corpening@nccourts.org [DSi,n1d R (tvFt,ln.tlni� N Viewed: 5/26/2022 12:28:14 PM Securit Level: Email Account Authentication 3DDSE15D4A2540C... Signed: 5/26/2022 12:28:47 PM Y 9 (None) Signature Adoption: Pre -selected Style Signed by link sent to julius.h.corpening@nccourts.org Using IP Address: 204.152.2.231 Electronic Record and Signature Disclosure: Accepted: 5/26/2022 12:28:14 PM ID:592d2cb4-a86b-46b4-b316-5a18f3babfe1 Martha Wayne, Interim CFO eDoe"�S�ignedby: Sent: 5/26/2022 12:28:49 PM mwayne@nhcgov.com C (�a+ IAX, �In� VA l,r Viewed: 5/26/2022 1:21:32 PM Security Level: Email, Account Authentication 9507FA3Fo5104E0... Signed: 5/31/2022 2:35:37 PM (None) Signature Adoption: Pre -selected Style Signed by link sent to mwayne@nhcgov.com Using IP Address: 70.63.86.17 Electronic Record and Signature Disclosure: Accepted: 5/26/2022 1:21:32 PM ID:70e8ed39-233d-487c-9e5d-d4b50942877d Signer Events Signature Timestamp Cindy Porterfield Sig -d by: Sent: 5/31/2022 2:35:39 PM cindy.porterfield@ncdps.gov �O CCD ""'0�d� `�'' Viewed: 6/3/2022 9:37:58 AM Director of Juvenile Community Programs 798FE7A4ED9F419.. Signed: 6/3/2022 9:38:04 AM NC Dept of Public Safety Signature Adoption: Pre -selected Style Security Level: Email, Account Authentication (None) Signed by link sent to cindy.porterfield@ncdps.gov Using IP Address: 45.37.201.178 Electronic Record and Signature Disclosure: Not Offered via DocuSign In Person Signer Events Signature Timestamp Editor Delivery Events Status Timestamp Agent Delivery Events Status Timestamp Intermediary Delivery Events Status Timestamp Certified Delivery Events Status Timestamp Carbon Copy Events Status Timestamp Witness Events Signature Timestamp Notary Events Signature Timestamp Envelope Summary Events Status Timestamps Envelope Sent Hashed/Encrypted 5/25/2022 7:16:28 PM Certified Delivered Security Checked 6/3/2022 9:37:58 AM Signing Complete Security Checked 6/3/2022 9:38:04 AM Completed Security Checked 6/3/2022 9:38:04 AM Payment Events Status Timestamps Electronic Record and Signature Disclosure Electronic Record and Signature Disclosure created on: 4/3/2018 2:57:43 PM Parties agreed to: LOUISE E HICKS, J H Corpening II, Martha Wayne, Interim CFO CONSUMER DISCLOSURE From time to time, NC Dept of Public Safety (we, us or Company) may be required by law to provide to you certain written notices or disclosures. Described below are the terms and conditions for providing to you such notices and disclosures electronically through the DocuSign, Inc. (DocuSign) electronic signing system. Please read the information below carefully and thoroughly, and if you can access this information electronically to your satisfaction and agree to these terms and conditions, please confirm your agreement by clicking the a€ -I agreea€TM button at the bottom of this document. Getting paper copies At any time, you may request from us a paper copy of any record provided or made available electronically to you by us. You will have the ability to download and print documents we send to you through the DocuSign system during and immediately after signing session and, if you elect to create a DocuSign signer account, you may access them for a limited period of time (usually 30 days) after such documents are first sent to you. After such time, if you wish for us to send you paper copies of any such documents from our office to you, you will be charged a $0.00 per -page fee. You may request delivery of such paper copies from us by following the procedure described below. Withdrawing your consent If you decide to receive notices and disclosures from us electronically, you may at any time change your mind and tell us that thereafter you want to receive required notices and disclosures only in paper format. How you must inform us of your decision to receive future notices and disclosure in paper format and withdraw your consent to receive notices and disclosures electronically is described below. Consequences of changing your mind If you elect to receive required notices and disclosures only in paper format, it will slow the speed at which we can complete certain steps in transactions with you and delivering services to you because we will need first to send the required notices or disclosures to you in paper format, and then wait until we receive back from you your acknowledgment of your receipt of such paper notices or disclosures. To indicate to us that you are changing your mind, you must withdraw your consent using the DocuSign a€ -Withdraw Consenta€TM form on the signing page of a DocuSign envelope instead of signing it. This will indicate to us that you have withdrawn your consent to receive required notices and disclosures electronically from us and you will no longer be able to use the DocuSign system to receive required notices and consents electronically from us or to sign electronically documents from us. All notices and disclosures will be sent to you electronically Unless you tell us otherwise in accordance with the procedures described herein, we will provide electronically to you through the DocuSign system all required notices, disclosures, authorizations, acknowledgements, and other documents that are required to be provided or made available to you during the course of our relationship with you. To reduce the chance of you inadvertently not receiving any notice or disclosure, we prefer to provide all of the required notices and disclosures to you by the same method and to the same address that you have given us. Thus, you can receive all the disclosures and notices electronically or in paper format through the paper mail delivery system. If you do not agree with this process, please let us know as described below. Please also see the paragraph immediately above that describes the consequences of your electing not to receive delivery of the notices and disclosures electronically from us. How to contact NC Dept of Public Safety: You may contact us to let us know of your changes as to how we may contact you electronically, to request paper copies of certain information from us, and to withdraw your prior consent to receive notices and disclosures electronically as follows: To contact us by email send messages to: david.pozun@ncdps.gov To advise NC Dept of Public Safety of your new e-mail address To let us know of a change in your e-mail address where we should send notices and disclosures electronically to you, you must send an email message to us at david.pozun@ncdps.gov and in the body of such request you must state: your previous e-mail address, your new e-mail address. We do not require any other information from you to change your email address.. In addition, you must notify DocuSign, Inc. to arrange for your new email address to be reflected in your DocuSign account by following the process for changing e-mail in the DocuSign system. To request paper copies from NC Dept of Public Safety To request delivery from us of paper copies of the notices and disclosures previously provided by us to you electronically, you must send us an e-mail to david.pozun@ncdps.gov and in the body of such request you must state your e-mail address, full name, US Postal address, and telephone number. We will bill you for any fees at that time, if any. To withdraw your consent with NC Dept of Public Safety To inform us that you no longer want to receive future notices and disclosures in electronic format you may: i. decline to sign a document from within your DocuSign session, and on the subsequent page, select the check -box indicating you wish to withdraw your consent, or you may; ii. send us an e-mail to david.pozun@ncdps.gov and in the body of such request you must state your e-mail, full name, US Postal Address, and telephone number. We do not need any other information from you to withdraw consent.. The consequences of your withdrawing consent for online documents will be that transactions may take a longer time to process.. Required hardware and software Operating Systems: WindowsA@ 2000, WindowsA@ XP, Windows Vista,&@; Mac OSA@ X Browsers: Final release versions of Internet Explorer,&@ 6.0 or above (Windows only); Mozilla Firefox 2.0 or above (Windows and Mac); Safaria„¢ 3.0 or above (Mac only) PDF Reader: AcrobatA@ or similar software may be required to view and print PDF files Screen Resolution: 800 x 600 minimum Enabled Security Settings: Allow per session cookies ** These minimum requirements are subject to change. If these requirements change, you will be asked to re -accept the disclosure. Pre-release (e.g. beta) versions of operating systems and browsers are not supported. Acknowledging your access and consent to receive materials electronically To confirm to us that you can access this information electronically, which will be similar to other electronic notices and disclosures that we will provide to you, please verify that you were able to read this electronic disclosure and that you also were able to print on paper or electronically save this page for your future reference and access or that you were able to e-mail this disclosure and consent to an address where you will be able to print on paper or save it for your future reference and access. Further, if you consent to receiving notices and disclosures exclusively in electronic format on the terms and conditions described above, please let us know by clicking the a€ -I agreea€TM button below. By checking the a€ -I agreea€TM box, I confirm that: • I can access and read this Electronic CONSENT TO ELECTRONIC RECEIPT OF ELECTRONIC CONSUMER DISCLOSURES document; and • I can print on paper the disclosure or save or send the disclosure to a place where I can print it, for future reference and access; and • Until or unless I notify NC Dept of Public Safety as described above, I consent to receive from exclusively through electronic means all notices, disclosures, authorizations, acknowledgements, and other documents that are required to be provided or made available to me by NC Dept of Public Safety during the course of my relationship with you.