HomeMy WebLinkAboutFY24 TEEN COURT PROGRAM AGREEMENTDocuSign Envelope ID: DBCDF166-A9CF-4BBE-BB9E-4ACED80BC47B
North Carolina Department of Public Safe
Juvenile Justice and Delinquency Prevention
JCPC Program - Program Agreement
SECTION I A: SPONSORING AGENCY AND PROGRAM INFORMATION
FUNDING PERIOD:
FY 23-24
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
1209-A Market Street
PHYSICAL ADDRESS:
Wilmington NC 28401
SPONSORING AGENCY
PO Box 398
MAILING ADDRESS:
Wilmington NC 28402
TYPE:
Non -Profit
(910) 343-1901 Fax: E-mail: Louise@ciscapefear.org
FEDERAL ID #120-3385755
COMPONENT ID # NAME OF PROGRAM COMPONENT PROGRAM TYPE TOTAL COST OF
EACH COMPONENT
38710 Mediation / Restorative Justice Mediation/Conflict Resolution $ 21,045
38711 Teen Court Teen Court $ 91,300
Total cost of components: $ 112,345
Program Manager Name & Address (same person on signature page)
Name:
Louise Hicks
Title:
Executive Director
Mailing
Address:
PO Box 398
City:
Wilmington
Zip:
28402
Phone:
(910) 343-1901 Fax: E-mail: Louise@ciscapefear.org
Contact Person (if different from program manager)
Name:
Marrio Jeter
Title:
Director of Operations
Mailing
Address:
PO Box 398
City:
Wilmington
Zip:
28402
Phone:
(910) 343-1901 Fax: E-mail: Marrio@ciscapefear.org
Program Fiscal Officer (cannot be program manager)
Name:
Jennifer Haslam
Title:
Finance Manager
Mailing
Address:
PO Box 398
City:
Wilmington
Zip:
28402
Phone:
(910) 343-1901 Fax: E-mail: Jennifer@ciscapefear.org
Form JCPC/PA 001 JCPC Program Agreement
Form structure last revised 12/31/2012
Department of Public Safety
DocuSign Envelope ID: DBCDF166-A9CF-4BBE-BB9E-4ACED80BC47B
SECTION I B: PROGRAM COMPONENT DESCRIPTION
COMPONENT ID #
COMPONENT INFORMATION
38710
NAME OF COMPONENT: Mediation / Restorative Justice
BRIEF DESCRIPTION: CIS Teen Court will provide New Hanover County youth with an
BRIEF DESCRIPTION: The CIS Mediation/Restorative Justice program is designed to mediate
opportunity for diversion from juvenile court. Trained adult and teen volunteers will act as court
disagreements between youth ages 10-18, who have been referred by SROs, law enforcement
officials and hear complaints against eligible offenders who are currently enrolled in school,
officials, school administrators, or juvenile court staff. Recognizing that students need to learn
admit guilt, and have no prior criminal history. Appropriate sentencing recommendations will be
how to resolve conflicts, staff trained in mediation and/or restorative Justice practices will guide
made including community service, restitution, restorative justice, and participation in future
referred youth through a structured process in an effort to help them come to a positive
Teen Court proceedings and skill -building programs.
resolution.
COMPONENT ID #
COMPONENT INFORMATION
38711
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.
Form JCPC/PA 001 JCPC Program Agreement
Form structure last revised 12/31/2012
Department of Public Safety
DocuSign Envelope ID: DBCDF166-A9CF-4BBE-BB9E-4ACED80BC47B
SECTION II: COMPONENT STATISTICAL INFORMATION
Multi -Components Yes
Component Service Statistics
PROGRAM COMPONENT INFORMATION - APPLICATION YEAR
Component Name: Mediation / Restorative Justice
Component ID #
38710
What is this component's maximum client capacity at any given time?
10
Frequency of client contact per month:
4
Anticipated Average Length of
Stay:
90
Days
y
Total Component Cost:
$21,045
- by
Estimated # to be served during funding period:
20
Estimated Average Cost Per Youth:
$1,052
Applies to
Actual number of youth admitted FY 21-22:
7
4
Number of admissions Juvenile Justice Referred
57.14% 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 21-22:
7
Form JCPC/PA 001 JCPC Program Agreement
Form structure last revised 01/09/2012
Department of Public Safety
DocuSign Envelope ID: DBCDF166-A9CF-4BBE-BB9E-4ACED80BC47B
SECTION III: 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). Referral sources include but are not limited to school administrators, counselors, school resource officers/law
enforcement, CIS Student Support Specialists, 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: DBCDF166-A9CF-4BBE-BB9E-4ACED80BC47B
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 (Yo) 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: DBCDF166-A9CF-4BBE-BB9E-4ACED80BC47B
SECTION III: COMPONENT SUMMARY
NAME OF COMPONENT: I Mediation / Restorative Justice
70% Clients successfully/satisfactorily completing the program will have no new complaints in the 12 months following
completion.
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 will have no new adjudications for a complaint with an offense date after the admission date.
90% Clients will demonstrate accountability for their actions within the scope of the mediation process.
70% Clients successfully/satisfactorily completing the program will have no new adjudications in the 12 months
following completion.
70% Clients will have no new complaints 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.
Of the 182 youths with completed YASI assessments in 2021, 30% were low-risk level, 43% were moderate, and 27%
were high. 51 % had previous referrals vs. 38% statewide; 29% reported having run away vs. 22% on the State level;
12% reported having been kicked out, double that of the state rate; 22% reported having a family member with mental
health issues vs. 15% on the State level; and 84% were living with someone other than their parents. 24% reported
being interested but not involved in school activities, while 39% reported having no interest in school activities at all,
16% reported having no consistent friends, 54% reported having negative peer influence, and 59% reported using
alcohol or drugs.
This program will address behavior problems, poor peer relationships, and youth with aggressive behaviors. School
administrators, 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.
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: DBCDF166-A9CF-4BBE-BB9E-4ACED80BC47B
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 either the CIS administrative office at 1209
Market Street, Wilmington, NC 28401 (next to New Hanover High School), or 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 office at 1209 Market Street, Wilmington, NC 28401, or 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 Dr. Kim Cook and her team 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 sources including but not limited to 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
Form JCPC/PA 001 JCPC Program Agreement
Form structure last revised 12/31/2012
Department of Public Safety
DocuSign Envelope ID: DBCDF166-A9CF-4BBE-BB9E-4ACED80BC47B
SECTION IV: COMPONENT NARRATIVE (attach for each component)
NAME OF COMPONENT:
Mediation / Restorative Justice
and goals will be given to 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: DBCDF166-A9CF-4BBE-BB9E-4ACED80BC47B
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: DBCDF166-A9CF-4BBE-BB9E-4ACED80BC47B
SECTION II: COMPONENT STATISTICAL INFORMATION
Multi -Components Yes
Component Service Statistics
PROGRAM COMPONENT INFORMATION - APPLICATION YEAR
Component Name: Teen Court
Component ID #
38711
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:
$91,300
- by
Estimated # to be served during funding period:
100
Estimated Average Cost Per Youth:
$913
Applies to
Actual number of youth admitted FY 21-22:
53
16
Number of admissions Juvenile Justice Referred
30.19% of total admissions
continuation
37
Number of admissions Law Enforcement Referred
69.81 % of total admissions
programs only.
0
Number of admissions District Court Referred
0% of total admissions
Actual number served FY 21-22:
53
Form JCPC/PA 001 JCPC Program Agreement
Form structure last revised 01/09/2012
Department of Public Safety
DocuSign Envelope ID: DBCDF166-A9CF-4BBE-BB9E-4ACED80BC47B
SECTION III: 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 2021 reported 671 juvenile complaints and a
delinquency rate of 23.39. Of those, 375 (56%) were minor Class 1-3 offenses. These types of defendants are less
likely to re -offend.
Of the 182 youths with completed YASI assessments in 2021, 30% were low-risk level, 43% were moderate, and 27%
were high. 51 % had previous referrals vs. 38% statewide; 29% reported having run away vs. 22% on the State level;
12% reported having been kicked out, double that of the state rate; 22% reported having a family member with mental
health issues vs. 15% on the State level; and 84% were living with someone other than their parents. 24% reported
being interested but not involved in school activities, while 39% reported having no interest in school activities at all,
16% reported having no consistent friends, 54% reported having negative peer influence, and 59% reported using
alcohol or drugs.
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 10-18, who have been petitioned or law enforcement referred for low-level
offenses. Partnerships with SROs, school administrators, 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. Referral sources include but are nol
limited to school administration, counselors, School Resource Officers, Juvenile Court Counselors, and CIS Student
Support Specialists. 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 beneficial services and positive interactions with
Form JCPC/PA 001 JCPC Program Agreement
Form structure last revised 12/31/2012
Department of Public Safety
DocuSign Envelope ID: DBCDF166-A9CF-4BBE-BB9E-4ACED80BC47B
SECTION III: COMPONENT SUMMARY
NAME OF COMPONENT:
Teen Court
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 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.
80% Clients will have no new complaints with an offense date after the admission date.
80% Clients will demonstrate improvement in developing and/or maintaining social and interpersonal interactions
during program participation.
80% Clients will have no new adjudications for a complaint with an offense date after the admission date.
80% Clients successfully/satisfactorily completing the program will have no new complaints in the 12 months following
completion.
80% Clients successfully/satisfactorily completing the program will have no new adjudications in the 12 months
following completion.
80% Clients will successfully or satisfactorily complete services as intended by the program design/service plan.
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 2021 reported 671 juvenile complaints and a
delinquency rate of 23.39. Of those, 375 (56%) were minor Class 1-3 offenses. These types of defendants are less
likely to re -offend.
Form JCPC/PA 001 JCPC Program Agreement
Form structure last revised 12/31/2012
Department of Public Safety
DocuSign Envelope ID: DBCDF166-A9CF-4BBE-BB9E-4ACED80BC47B
SECTION III: COMPONENT SUMMARY
NAME OF COMPONENT: I Teen Court
Of the 182 youths with completed YASI assessments in 2021, 30% were low-risk level, 43% were moderate, and 27%
were high. 51 % had previous referrals vs. 38% statewide; 29% reported having run away vs. 22% on the State level;
12% reported having been kicked out, double that of the state rate; 22% reported having a family member with mental
health issues vs. 15% on the State level; and 84% were living with someone other than their parents. 24% reported
being interested but not involved in school activities, while 39% reported having no interest in school activities at all,
16% reported having no consistent friends, 54% reported having negative peer influence, and 59% reported using
alcohol or drugs.
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: DBCDF166-A9CF-4BBE-BB9E-4ACED80BC47B
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
1209 Market Street, 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
1209 Market Street 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, school administrators, 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: DBCDF166-A9CF-4BBE-BB9E-4ACED80BC47B
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.
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, school administrators, 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.
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
Form JCPC/PA 001 JCPC Program Agreement
Form structure last revised 12/31/2012
Department of Public Safety
DocuSign Envelope ID: DBCDF166-A9CF-4BBE-BB9E-4ACED80BC47B
SECTION IV: COMPONENT NARRATIVE (attach for each component)
NAME OF COMPONENT:
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 referring agency 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.
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, school administrators, 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
Form JCPC/PA 001 JCPC Program Agreement
Form structure last revised 12/31/2012
Department of Public Safety
DocuSign Envelope ID: DBCDF166-A9CF-4BBE-BB9E-4ACED80BC47B
SECTION IV: COMPONENT NARRATIVE (attach for each component)
NAME OF COMPONENT: I Teen Court
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.
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
Form JCPC/PA 001 JCPC Program Agreement
Form structure last revised 12/31/2012
Department of Public Safety
DocuSign Envelope ID: DBCDF166-A9CF-4BBE-BB9E-4ACED80BC47B
SECTION IV: COMPONENT NARRATIVE (attach for each component)
NAME OF COMPONENT:
Teen Court
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: DBCDF166-A9CF-4BBE-BB9E-4ACED80BC47B
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, 2023 and shall terminate Jun 30, 2024.
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: DBCDF166-A9CF-4BBE-BB9E-4ACED80BC47B
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: DBCDF166-A9CF-4BBE-BB9E-4ACED80BC47B
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 11C
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: DBCDF166-A9CF-4BBE-BB9E-4ACED80BC47B
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 11 B. 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
transactions and agreements relating to it, and their situs and forum, shall be Wake County, North Carolina, where all
Form structure last revised 12/20/2013
Department of Public Safety
DocuSign Envelope ID: DBCDF166-A9CF-4BBE-BB9E-4ACED80BC47B
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.
Accountability for Funds
Form structure last revised 12/20/2013
Department of Public Safety
DocuSign Envelope ID: DBCDF166-A9CF-4BBE-BB9E-4ACED80BC47B
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.
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.
Form structure last revised 12/20/2013
Department of Public Safety
DocuSign Envelope ID: DBCDF166-A9CF-4BBE-BB9E-4ACED80BC47B
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,
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
Form structure last revised 12/20/2013
Department of Public Safety
DocuSign Envelope ID: DBCDF166-A9CF-4BBE-BB9E-4ACED80BC47B
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: DBCDF166-A9CF-4BBE-BB9E-4ACED80BC47B
SECTION VI: BUDGET NARRATIVE
Teen Court & Mediation (Restorative Justice)
Fiscal Year
FY 23-24
Item #
Justification
Expense
In Kind Expense
120
Value of in-kind volunteers (teens @ 8/hour; professionals /
adults @ $23.07/hour)
$46,350
$20,000
120
Teen Court / Restorative Justice Program Coordinator; 1 FTE
$46,350
Program Director $643.75 per month x 12 months
120
Administrative support - payroll / accounts payable & receivable
- 2 hours per week; $26.44 per hour
$2,750
$69,065
120
Program Director - Project Management and oversight; .15 FTE
$7,725
120
Teen Court / Restorative Justice Assistant; 20 hours per week;
$17 per hour; 36 weeks
$12,240
180
Medical Benefits for FTE (prorated as applicable) estimated @
4%
$2,275
180
FICA @.0765%; Worker's Comp @.0168%; SUI @.0084%
$5,970
220
Food/Refreshments as needed for teen court nights, training,
special teen court functions, and end of year activities
$6,600
260
Office supples (paper, ink, misc. supplies)
$2,000
290
Student materials for Teen Court sessions estimated @ $50
per month x 10 months
$500
310
Local mileage estimated @ 150 miles per month, 11 months, .
565 per mile
$935
390
Staff development: travel & training
$5,000
TOTAL
$92,345
$20,000
Job Title
Annual Expense
wages
Annual In Kind
wages
Teen Court / Restorative Justice volunteers
$20,000
Teen Court / Restorative Justice Program Assistant $1020 per month x 12
months
$12,240
Teen Court / Restorative Justice Program Coordinator $3862.50 per month x 12
months
$46,350
Administrative Support - payroll / accounts payable & receivable $229.17 per
month x 12 months
$2,750
Program Director $643.75 per month x 12 months
$7,725
TOTAL
$69,065
$20,000
Form JCPC/PA 001 JCPC Program Agreement
Form structure last revised 12/31/2012
Department of Public Safety
DocuSign Envelope ID: DBCDF166-A9CF-4BBE-BB9E-4ACED80BC47B
SECTION VII: BUDGET NARRATIVE LINE ITEM SUMMARY
Program: Teen Court & Mediation (Restorative Justice)
Fiscal Year: FY 23-24 Number of Months: 12
Form JCPC/PA 001 JCPC Program Agreement
Form structure last revised 12/31/2012
Department of Public Safety
Cash
In Kind
Total
I. Personnel Services
$77,310
$20,000
$97,310
120 Salaries & Wages
$69,065
$20,000
$89,065
180 Fringe Benefits
$8,245
$8,245
190 Professional Services*
$0
*Contracts MUST be attached
II. Supplies & Materials
$9,100
$9,100
210 Household & Cleaning
$0
220 Food & Provisions
$6,600
$6,600
230 Education & Medical
$0
240 Construction & Repair
$0
250 Vehicle Supplies & Materials
$0
260 Office Supplies and Materials
$2,000
$2,000
280 Heating & Utility Supplies
$0
290 Other Supplies and Materials
$500
$500
III. Current Obligations & Services
$5,935
$5,935
310 Travel & Transportation
$935
$935
320 Communications
$0
330 Utilities
$0
340 Printing & Binding
$0
350 Repairs & Maintenance
$0
370 Advertising
$0
380 Data Processing
$0
390 Other Services
$5,000
$5,000
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
$20,000
$112,345
Form JCPC/PA 001 JCPC Program Agreement
Form structure last revised 12/31/2012
Department of Public Safety
DocuSign Envelope ID: DBCDF166-A9CF-4BBE-BB9E-4ACED80BC47B
SECTION VIII: SOURCES OF PROGRAM REVENUE (ALL SOURCES)
FY 23-24 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)
$20000 Local In -Kind 1 CIS Cape Fear Volunteers
(Specify Source)
Other
(Specify Source)
Other
(Specify Source)
Other
(Specify Source)
Other
(Specify Source)
$112,345 TOTAL $18,469
$20,000
Required Local Match
Match Provided
e—DocuSigned by:
�--7ARFF7A4Rn9F419
6/14/2023
Authorizing Official, Department of Public Safety
Date
The following signature certifies that this program agreement has been locally approved by the Board of County
Commissioners.
,—DocuSigned by:
�' I
t`L (A,&
�c6B88cFc5D1A4B5...
6/13/202 3
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.
e—DocuSigned by:
J R '� '" uu 11
`-3f)nAF15f)4A2540C
6/12/2023
Chair, Juvenile Crime Prevention Council
Date
e—DocuSigned by:
�_— �f177RnRSRR7Rd5F
6/12/2023
Program Manager
Date
Form JCPC/PA 001 JCPC Program Agreement
Form structure last revised 12/31/2012
Department of Public Safety
DocuSign Envelope ID: DBCDF166-A9CF-4BBE-BB9E-4ACED80BC47B
INTERNAL REVENUE SERVICE
P. 0. BOX 2508
CINCINNATI, OH 45201
Date: MAY 10 2006
CCMMpNITIES 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:
17053086020015
Contact Person:
NANCY L F?EAGNEY ID# 31346
Contact Telephone Number.
(877) 829-5500
Accounting Period Ending:
June 30
Public Charity Status:
170(b) (1) (A) (vi)
Form 990 Required:
Yes
Effective Date of Exemption:
June 1, 2045
Contribution Deductibility:
Yes
Advance Ruling Ending Date:
June 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 income 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, 2106
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
501(c)I3) for some helpful information about your responsibilities as an exempt
organization.
Letter 1045 (DO/CG)
DocuSign Envelope ID: DBCDF166-A9CF-4BBE-BB9E-4ACED80BC47B
DKRKt .�e
r...im mover. oan.we
V •�. �• 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. 1430.6-23 (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 13 001) along with the agency's conflict of interest policy when applying for 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. �/ic-siopf
WHEREAS, (Name of entity) !- e) to ooh 01 (�!
desires to require its Board of Directors and managing employees to avoid con
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 2022
NC Department of Public Safety
Pagel of 3
DocuSign Envelope ID: DBCDF166-A9CF-4BBE-BB9E-4ACED80BC47B
ep. sw� y
•,a;, �• NOT FOR PROFIT
DPS CONFLICT OF INTEREST POLICY STATEMENT
0EPAR7/AE4TMF WBC SAFfin
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/JCPC Council all conflicts of interest, if "yes" is answered to any
of the following, see directions on page 3: (Check all that apply)
Form DPS 13 001 Not for Profit DPS Conflict of Interest Policy Statement
Form structure last revised July 2022
NC Department of Public Safety Page 2 of 3
YES
NO
1.
A Board member is related to a staff member.
❑
2.
A staff member in a supervisory capacity is related to another staff
member whom he/she supervises.
❑
3.
A staff member is related to another staff member.
❑
4.
A board member or staff member has or may have personal,
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
participates that may be viewed as having direct or indirect influence
❑
over the private, non rofit enti 's business.
6.
A staff, board, or family member may be viewed as having direct 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 compensation
outside of the scope of employmentloperations with the private,
❑
nonprofit entity that creates or appears to create bias.
8.
A staff or board member secured employment with a competitor or
other similar private, nonprofit entity.
❑
9.
Ongoing, paid consulting work outside of the staff member's 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 2022
NC Department of Public Safety Page 2 of 3
DocuSign Envelope ID: DBCDF166-A9CF-4BBE-BB9E-4ACED80BC47B
V DM3
i of r�euc s.uerr
�•NOT FOR PROFIT
•�a,,,,,,�•
DPS CONFLICT OF INTEREST POLICY STATEMENT
1. If "yes" is checked to any of the aforementioned items, the .ICPC 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.
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: V e vi 0)10
Agency's Name:
(Legal Applicant) I wjj
Federal Tax ID ##: a ' 5 J
Private, Nonprofit
Entity Name: Co1Movrh- 5
Executive Director's Print Use, I . a IC
Name: Sign
Board Chair's Print
Name: Sign
Sworn to and subscribed before me on the
Day of the date of said certification
otary
Date
Form DPS 13 001 Not for Profit DPS Conflict of Interest Policy Statement
Form structure last revised July 2022
NC Department of Public Safety
(Date of
(Date of Signature)
Page 3 of 3
DocuSign Envelope ID: DBCDF166-A9CF-4BBE-BB9E-4ACED80BC47B
1ik
��
Communities
In Schools
Cape F"
May 26, 2023
To: State Agency Head and Chief Fiscal Officer
Certification:
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 Stephanie Kraybill, being duly sworn, say that they are the Board Chair and Vice Chair,
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.
JIMIllusby, Board Chair `
Stephanie raybill, Vice Chair
Sworn to and Subscribed before me on the day of the date of said certification.
My Commission Expires:
( ry Sign)aure and Seal)
Communities In Schools of Cape rear, PO Box 398, Wilmington, N.C. 28402
910-343-1901; 910-343-8566 (fax); www.ciscapefear. or
DocuSign Envelope ID: DBCDF166-A9CF-4BBE-BB9E-4ACED80BC47B
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.cisciipefear.org
DocuSign
Certificate Of Completion
Envelope Id: DBCDF166A9CF4BBEBB9E4ACED80BC47B
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
6/12/2023 2:39:24 PM
Signer Events
LOUISE E HICKS
Louise@ciscapefear.org
Executive Director
Security Level: Email, Account Authentication
(None)
Electronic Record and Signature Disclosure:
Accepted: 6/4/2020 3:49:54 PM
ID:62e44c5f-6edb-4650-bOc5-dc41ab71686a
J H Corpening II
julius.h.corpening@nccourts.org
Security Level: Email, Account Authentication
(None)
Electronic Record and Signature Disclosure:
Accepted: 6/12/2023 4:21:54 PM
ID: ebed 0b5e-df07-4eae-bce7-af7227f24e6f
Eric Credle
ecredle@nhcgov.com
Security Level: Email, Account Authentication
(None)
Electronic Record and Signature Disclosure:
Accepted: 6/13/2023 8:16:44 AM
ID: 4470971b-c3e2-401f-a41b-bf49e0a7404d
Cindy Porterfield
cindy.porterfield@ncdps.gov
Director of Juvenile Community Programs
NC Dept of Public Safety
Security Level: Email, Account Authentication
(None)
Electronic Record and Signature Disclosure:
Not Offered via DocuSign
Holder: DPS-DJJ Community Programs Location: DocuSign
djjdp.applicationsupport@ncdps.gov
Signature Timestamp
CDocuSigned by: Sent: 6/12/2023 2:39:26 PM
bI"ISf le NUS Viewed: 6/12/2023 2:41:29 PM
3D778065587B45F...
Signed: 6/12/2023 2:41:37 PM
Signature Adoption: Pre -selected Style
Using IP Address: 174.106.51.232
ED ... Sig -d by: Sent: 6/12/2023 2:41:39 PM
� ""VpUu" Viewed: 6/12/2023 4:21:54 PM
30D8E1504A2540c... Signed: 6/12/2023 4:22:01 PM
Signature Adoption: Pre -selected Style
Using IP Address: 204.152.2.231
EDOCUSigned by: I' Sent: 6/12/2023 4:22:03 PM
tIG t rLD�u Viewed: 6/13/2023 8:16:44 AM
c6B68CFc5D1A4B5... Signed: 6/13/2023 5:49:02 PM
Signature Adoption: Pre -selected Style
Using IP Address: 152.31.193.130
ED—Sig"ed
by: Sent: 6/13/2023 5:49:04 PM
ti.d� �otit�Ed Viewed: 6/14/2023 6:20:01 PM
798FE7A4BD9F419... Signed: 6/14/2023 6:20:05 PM
Signature Adoption: Pre -selected Style
Using IP Address: 199.90.60.4
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
6/12/2023 2:39:27 PM
Certified Delivered
Security Checked
6/14/2023 6:20:01 PM
Signing Complete
Security Checked
6/14/2023 6:20:05 PM
Completed
Security Checked
6/14/2023 6:20:05 PM
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, Eric Credle
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
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satisfaction and agree to these terms and conditions, please confirm your agreement by clicking
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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.
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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
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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;
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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..
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** 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.