*The high school student's primary parent/guardian must complete this application and consent form.
*I understand participation in this IPP is evaluating individuals with intellectual/developmental disabilities.
*I understand that a request for any information pertaining to participation records while actively engaged in the pilot program may be requested.
*I understand the duration of participation may/will be ongoing and could last up to three (3) years or thirty-six (36) months from start date.
*I understand non-compliance with the pilot could result in dismissal, and could forgo any benefits associated with the IPP.
*I understand my and my high school child's personal information being shared for the purposes of this IPP. I agree and understand participating in this IPP includes sharing of personal financial wellness indicators and personal health indicators data. This data will be analyzed and aggregated, and participants agree that this information will be shared with the IPP grantees (Balanced Cents, LLC; Brad Nelson, Merry Juerling, Cameron Moore), BDDS, other state/federal entities and media as needed to show effectiveness of and market this IPP, potential ongoing and related services.
*I understand my and my high school child's information on this Consent/Application and IPP surveys are collected through and applicable to, and I have read and agree to, Survey Monkey's Privacy Notice.
*I agree to provided applicant data to be verified by Indiana BDDS for high school student's waiver participation verification.
*I understand I may reasonably expect to receive a financial incentive for participation in the pilot only if I abide by the requirements of the IPP.
*I understand that my and my high school child's participation in this IPP is voluntary, that my refusal will involve no penalty or loss of benefits to which I am otherwise entitled, and that I may discontinue participation at any time without penalty or loss of benefits to which I am otherwise entitled. I understand that if l decide to discontinue my participation in the pilot, my information and data collected could still be used for the time of my participation.
*I understand that participating in this pilot does not constitute an employer employee relationship.
*I understand I cannot hold any individuals, organizations, their officers or boards associated with this pilot liable for any damages I may incur while participating in the pilot.
*I understand two (2) cohorts of high school students on a BDDS waiver and up to 2 parent(s)/guardian(s) per student will be selected to participate during the cohorts starting 10/24/2023 and 1/2/2024, and due to a limited number of IPP spots, not all applicants may be selected.
*I understand the high school student applicant must both be enrolled in high school for the 2023-2024 school year and live in one of the following Indiana counties: Boone, Hamilton, Hendricks, Marion, Hancock, Morgan, Johnson or Shelby.
*I understand each selected family will be given one membership access for the Roots of Personal Finance program to share with the high school student and parent(s)/guardian(s). The membership account will be assigned to the primary parent on the IPP application and access will be granted for one year.
*I understand in addition to the free one-year membership, families will also receive a free copy of the Totally Awesome Debt Freedom Planner.
*I understand the email addresses of both the primary parent/guardian and the student will be used for two mandatory surveys and communication throughout the IPP.
*I understand closed captions will be available for this IPP's videos; however, no translation services are available for required and/or optional meetings or required surveys. Each cohort will have a mandatory IPP Beginning and End Meeting, and optional weekly Meet Up Meetings throughout the 12-week program, and two mandatory surveys.
*I understand IPP participants must have the ability to read, write and speak basic English and perform basic math.
*I understand I must have access to a stable Internet connection, a laptop or computer and my email to participate. Access to a printer is helpful. I understand if accessing online meetings in a public place, headphones or earbuds will be needed.
*I understand and agree to abide by Balance Cents, LLC’s Terms of Use for the Roots of Personal Finance program at Balanced Cents Financial Coaching, LLC Terms of Use.
*I understand that I may find a list of Frequently Asked Questions.
*I understand if I have any questions concerning this IPP, I may email my questions to [email protected].
*I understand my application will not be submitted until I click the “Done” button at the end of this form.