Application for Assistance

Contact Information

Background Information

This information is collected for grant reporting purposes only, is kept confidential and has no affect your eligibility.

About Your Adoption

What Are You Looking For

Current Support

Emergency Contact Information

Anything Else?

Client's Rights and Responsibilities

The Rights and Responsibilities listed below have been created for the benefit of our clients. Following these guidelines helps to ensure that you will get the most out of the services offered by Shared Journeys Birthparent Collective, that your experience will be productive and beneficial to you, and that you will be successful in attaining your goals. 

As a Shared Journeys Client, you have the right to:

1. Be treated with respect and dignity, without discrimination.

2. Services that are appropriate, professional, courteous, caring, and timely.

3. Privacy and confidentiality.

4. Expect that Shared Journeys staff will work together to provide support that best fits your needs.

5. Work together with Shared Journeys staff to develop goals.

6. Your own feelings and values.

7. Be listened to and ask questions or express concerns.

8. Respectfully disagree.

9. Consent to or decline services.

10. Expect Shared Journeys to apply eligibility criteria fairly and impartially.

11. Receive service at times mutually convenient to you and Shared Journeys staff during customary business hours (Weekdays from 8am-5pm CST) or by appointment on evenings and weekends. Shared Journeys is not a crisis management organization and services are not available 24/7. 

12. Receive services provided your behavior does not disrupt, threaten, or harm other clients or staff. Non-compliance may result in discharge from services.

13. Not be denied, suspended or terminated from services or have services reduced for exercising any rights provided staff and clients are treated respectfully.

14. Make a complaint. If you believe you have not received fair treatment or adequate services, you have the right to speak with Shared Journey's Executive Director.

As a Shared Journeys Birthparent Collective Client, you are responsible for:

1. Providing accurate and complete information and providing necessary documentation, as needed. This includes following through on pending documentation to engage in Shared Journeys programs and services as well as notifying Shared Journeys staff if your contact information (email, phone number, address) changes.

2. Asking questions to make sure you understand the services you will receive and any instructions.

3. Being respectful of Shared Journeys’ time, boundaries and limitations including keeping your appointment, changing or canceling scheduled appointments in a timely manner (min 24 hrs notice outside of emergency situations), as well as using Shared Journeys' programs and services wisely and not wasting resources. 

4. Not discriminating against Shared Journeys staff or clients on the basis of race, religion, gender identity, or sexual orientation.

5. Communicating with Shared Journeys staff if you have concerns or suggestions about the support you receive so that we can work together to provide you with the best possible service in the future.

6. Being respectful of Shared Journeys staff and clients by listening to others when you are participating in any of Shared Journeys' support calls, events, retreats, and engaging in our social media pages or groups.

7. Maintaining the confidentiality of other Shared Journeys clients when participating in any Shared Journeys support calls, events, retreats, or engaging on our social media pages or groups.

8. Acknowledging that violent, abusive, demeaning, intimidating, and/or aggressive language and behaviors will not be tolerated. The use of violent, abusive, demeaning and/or intimidating behaviors or language with Shared Journeys staff or clients may result in immediate termination of services.

9. Fostering an environment where the above is available to all members when participating in any of Shared Journeys' support calls, events, retreats, and engaging in our social media pages or groups.

Shared Journeys Staff reserves the right to:

1. Determine how its limited resources are best distributed fairly to all clients. 

2. Recognize that, as a remote and adoption-focused organization, there are times when our clients' needs are more intensive than we are safely able to address.  We reserve the right to refer a client to other community organizations in order to work on issues outside of adoption.

3. Determine if and when it is appropriate to reinstate client services and involvement in Shared Journeys programs when services have been paused or terminated. 

4. Mute or remove a client from Shared Journeys support calls, events, retreats and/or social media groups if the client exhibits violent, abusive, demeaning, intimidating, and/or aggressive language or behaviors.

5. Terminate a phone call, zoom call, or in person meeting with client if the client has been  informed that the client's language or behavior is not appropriate or is creating an unhealthy or unsafe interaction, and the language or behavior does not improve.

Consent and Release of Information

I, name entered below, give permission to Shared Journeys Birthparent Collective to exchange or release information regarding adoption services. I also give permission for Shared Journeys Birthparent Collective to contact references and the adoption agency and/or adoption attorney that provided services during pregnancy and placement.

I am aware that Shared Journeys Birthparent Collective uses the information gathered for the purposes of improving services, developing new programs and securing funding and that some of the information provided above may be used for these purposes. I am also aware that Shared Journeys Birthparent Collective may use parts of my story in printed materials and/or website/social media pages. I understand that Shared Journeys Birthparent Collective will never share confidential or identifying information about me such as photos, names or contact information without my express, written consent and that Shared Journeys Birthparent Collective will seek my permission prior to sharing anything related to my story. 

By signing this release, I understand this allows all pertinent Shared Journeys Birthparent Collective personnel/staff to collaborate on my behalf as a team, to provide the best services deserved to me.

Thank you for reaching out — we are truly honored you are here. Our team will be in touch soon to get you connected with a case manager. In the meantime, you are always welcome to join a Connect Call or reach out directly at jennifer@sharedjourneyscollective.org. You don't have to wait to be part of this community.