Host Family Shared Housing Agreement

(Adapted from First Place for Youth)

Adult Roles and Responsibilities

I agree to:

  1. Demonstrate commitment to being a permanent connection in this youth’s life, including providing emotional support and mentoring.
  2. Provide a safe living environment in my home for at least two years or until the day before the youth’s 24th birthday, or whichever one comes first. I understand that this housing must provide sufficient space for the youth and be clean and well kept.
  3. Incorporate the shared values statement that is created together into the household and the relationship with the youth.
  4. Support the youth in achieving the goals outlined in the Transitional Independent Living Plan (TILP) and case plan.
  5. Provide as much freedom as possible to prepare the youth to successfully live independently.
  6. Collaborate with the THP-Plus Case Manager and other service providers to support the youth in meeting the goals of their TILP.
  7. Attend monthly house meetings with the youth and the THP-Plus Case Manager.
  8. Support youth in developing a housing plan after completion of the program if remaining in the home is not an option.
  9. Support youth in developing a plan to stay in the home if remaining in the home is an option.
  10. Abide by the rules and agreements outlined in the household agreement.
  11. Work on communicating concerns and ideas to the youth and to continuously improve communication.
  12. Respect the youth’s confidentiality and right to privacy.

Participant Roles and Responsibilities

I agree to:

  1. Demonstrate commitment to being an active participant within the home, within the relationship with the permanent adult, and within the Host Family Program.
  2. Incorporate the shared values statement that is created together into the household and relationship with the adult.
  3. Pursue the goals and participate in the activities outlined in my Transitional Independent Living Plan (TILP) and case plan.
  4. Respect the freedom provided me as an opportunity to prepare myself to successfully transition into independent living.
  5. Attend weekly meetings in the home with the THP-Plus Case Manager and monthly house meetings with the adult and the THP-Plus Case Manager.
  6. Abide by the rules and agreements outlined in the household agreement.
  7. Follow all housing policies as listed in the participant contract.
  8. To work on communicating concerns and ideas to the permanent adult and to continuously improve communication.

We agree to abide by the roles and responsibilities listed above.

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Youth’s NameYouth’s SignatureDate

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Host Family’s NameHost Family’s SignatureDate

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Case Manager’s NameCase Manager’s SignatureDate

Shared Values Statement

SHARED VALUES STATEMENT

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