FAMILY PEACE INITIATIVE BIP PARTICIPATION AGREEMENT

FAMILY PEACE INITIATIVE BIP PARTICIPATION AGREEMENT

STRUCTURE: The Family Peace Initiative Program (FPI) is a minimum of 27 weeks. This includes the assessment, orientation, and a minimum of 25 weekly sessions. Disruptive behaviors or lack of active, respectful participation can be cause for further recommendations, extended programming, or termination. If my victimization includes a child, I understand an apology and reparation process will be facilitated prior to completion of the program.*

I HAVE READ THE ABOVE AND AGREE: (check box below)

CONFIDENTIALITY: In participating in FPI I agree to respect the confidentiality of others in the program. Please Note: In some cases, the Family Peace Initiative sessions will be held through a virtual platform. In order to help maintain confidentiality I understand that during virtual sessions I must: A) Be in a private and secure space where it is just me, B) Have my camera on, C) Limit my motion to what is necessary, keeping my face inside the camera view and proper lighting so all expressions are easily visible, D) Utilize earbuds or headphones, and E) Log out of the video conference immediately if my space is not private and log back in once I get to a private and secure space.*

I HAVE READ THE ABOVE AND AGREE: (check box below)

CONVERSATION ETIQUETTE: I agree to wait for others to finish speaking before I start speaking. If I am attending a virtual session, I agree to mute my mic unless I am speaking.*

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GROUP ETIQUETTE: During the session I agree to be fully present. To demonstrate this, I agree to pay attention, be appropriately dressed, and to keep phones and other technology turned off. If attending virtually, I will only use the phone or computer needed to attend the group and will not be using it for other purposes during the meeting.*

I HAVE READ THE ABOVE AND AGREE: (check box below)

TARDIES/PRESENT NO CREDIT: I understand that I am expected to be on time for sessions. If I am running late, I agree to call and give notice that I will be late. The main office phone number is 785-350-2858. I understand if: A) I am late and do not communicate with the office or my group facilitator, B) I am more than 15 minutes late, or C) I leave more than 15 minutes early, I will not receive credit for that session. Instead, I will receive a "Present No Credit" (PNC), meaning I was “present” in the session but did not attend long enough to receive “credit.” I am not charged for a “PNC” and it does not count as an absence. A “PNC” is also given when I am unengaged, sleeping, leaving the room repeatedly, or having technical problems. Examples include: bad reception, phone issues, or extended disconnection.*

I HAVE READ THE ABOVE AND AGREE: (check box below)

ABSENCES: I understand I am allowed a total of 3 absences during participation in FPI. If I call before the session has started, the absence will be counted as excused. Any absence without communicating with the FPI office or your facilitator before the group has started is considered “unexcused”. All unexcused absences will be charged at the full rate. If 4 absences have accumulated, I understand that I am out of integrity by being over the absence limit. To “fix” this I can: 1) come to agreement with my facilitators and group about what I can do as an assignment to get back into integrity, 2) start my group sessions over or be backed up to Week 18 if I am already past Week 18, or 3) end my participation with FPI. However, if I accumulate 4 consecutive absences or obtain 5 absences or more, then repairing it is no longer an option. I will need to decide whether I would like to end my participation, start over, or, if I am past Week 18, have my group sessions backed up to Week 18.*

I HAVE READ THE ABOVE AND AGREE: (check box below)

CORRECTED ABSENCE NO CREDIT: To “fix” an absence I understand I can talk with my group facilitators about completing an assignment on the topic that was covered the day that I missed. That assignment must be brought back to the next group session and presented to the group. A correction repairs the absence. I am not charged for the correction and it does not count as credit towards the 27 group sessions needed to complete.*

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PROGRAM BALANCE: I understand I can carry a balance with FPI of up to $99.00. If my balance reaches $100 or more, I will need to make a payment to bring my balance under $100 to receive credit. If I cannot make a payment, I will be allowed to attend and receive a PRESENT NO CREDIT DUE TO FINANCES (PNCF) for up to 3 consecutive weeks. If my balance is over $100 after receiving 3 consecutive PNCF, I will be placed on financial suspension until I am able to meet the financial requirements of FPI. I also understand that all payments, including payment for the final group session, must be completed before doing the week 27 process.*

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PAYMENT METHOD: Payments may be conducted in person, online, and by mail. I understand that I can make a payment by either calling the office during office hours or by going to the FPI website at: www.familypeaceinitiative.com/store and clicking on the "Group Fees" option or by mailing a check or money order to: FPI, 200 SW 33rd Street, Topeka, KS 66611.*

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WEEK 18/WORKBOOK: I understand I am required to purchase and complete the FPI Workbook. This workbook will be reviewed by staff periodically. I also understand that on my 18th session I must complete a week 18 presentation and anything that has been assigned in the workbook up to that point. Both must be completed satisfactorily to enter into the completion phase of FPI, weeks 19 through 27.*

I HAVE READ THE ABOVE AND AGREE: (check box below)

UNDER THE INFLUENCE: I agree to not be under the influence of drugs or alcohol during any program session. If it is suspected that I have been drinking or using illegal drugs prior to attending a session, I will be asked to leave. There will be no discussion about this. I also understand I will receive a present no credit (PNC) for that session and it will be reported to my probation/parole officer or other referral source.*

I HAVE READ THE ABOVE AND AGREE: (check box below)

VICTIM CONTACT: I understand that my victim, previous victims, partner, and subsequent partners will be contacted for an interview periodically during the program and in follow up after I graduate from the program. I agree to provide contact information so these contacts can be completed. If I am aware of a change in their contact information, I will provide it. If I become involved in a new relationship, I will provide the contact information to my group facilitators immediately.*

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NON-VIOLENCE: I understand that I must remain non-violent for a period of four (4) consecutive months prior to completion of the program. Any act of violence will cause the four-month period to start over.*

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VIOLENCE REPORTED: I understand that any act of violence which constitutes a crime will be reported to the proper authorities and referral source.*

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WEAPONS: I understand that I cannot have any weapons or objects that can be used as a weapon during the group session. This includes items that may be used as a part of work attire such as box cutters, knives, guns, or mace.*

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DATA COLLECTION: I understand that any data collected by FPI concerning my case may be used for research purposes without revealing my name or identifying information. I may refuse to have information on my case used or drop out of the research at any time without negative consequences.*

Select option below:

YES it may be used.

NO it may not be used

COMPLETION: I understand that when I have completed FPI, I have a lifetime invitation to return to BIP groups as a graduate at no cost to me, unless I am charged with a new domestic violence offense, or mandated or referred by an agency or court. In those cases, I am welcome to come back, but I will have to pay for services. If I return as a graduate, I understand this participation agreement, with the exception of the fees, will still be in place, including victim/partner contacts.*

I HAVE READ THE ABOVE AND AGREE: (check box below)

SIGNATURE

Participant ID

You will find your Participant ID in the email that was sent to you. This is not required, if you enter this ID then the Forms Completed field is updated.

Participant Name (E-Signature)*

Date*

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