Bravehope Partners — Service Agreement & Release of Information

Please review both documents below, fill in your information, and sign electronically. You can sign one or both — whichever applies to you right now.

Participant Information

These details are used on both documents below.

Release of Information

This is to inform you that I am authorizing your regional center and its staff to provide access to and copies of all documents contained in my / my son's / my daughter's file to Bravehope Partners and its staff. The regional center is also authorized to discuss my / my son's / my daughter's services and case with Bravehope Partners and its staff. Bravehope Partner and its staff are also authorized to provide information about me / my son / my daughter to your regional center and its staff. This consent is valid for one year from the date signed unless I revoke it in writing prior to that date.

Person-Centered Planning & SDP Transition Services Agreement

1. Parties. This Agreement is between Bravehope Partners, LLC ("Facilitator") and the person signing below ("Client"), the participant or the participant's authorized representative, for services provided to the participant identified above as they begin and enter California's Self-Determination Program (SDP).

1. Parties

This Agreement is between Bravehope Partners, LLC ("Facilitator") and the person signing below ("Client"), the participant or the participant's authorized representative, for services provided to the participant identified below as they begin and enter California's Self-Determination Program (SDP).

2. Services

A. Person-Centered Planning (service code 024)

Facilitator will facilitate and prepare the participant's Person-Centered Plan (PCP), including interviews with the participant and family, a person-centered planning process, and a written PCP delivered to the family and the Regional Center. The PCP is the foundational document used to build the participant's SDP services and budget.

B. SDP Transition Services (service code 099)

Following the plan, Facilitator will provide transition support to help the participant enroll in and start SDP. Depending on the participant's needs, this may include spending-plan development, budget coordination, Regional Center negotiation and follow-up, coordination with the Financial Management Services (FMS) provider, and setting up authorized services and providers so services can begin.

3. Fees and Payment

Person-Centered Plan (024): a flat fee of $1,000 for the completed PCP, payable as purchase reimbursement through the Regional Center (no vendorization required).

Transition Services (099): billed hourly at the State-established rate for service code 099, up to the authorized number of hours, and paid from the participant's authorized SDP budget through the Regional Center and/or FMS.

Where the plan or transition requires additional time — for example, lack of natural supports, a preferred language other than English, or a higher level of need — additional PCP funding or additional 099 hours may be requested from the Regional Center / IPP team on a case-by-case basis.

4. Authorization Required (No Authorization, No Start)

Transition Services (099) begin only once the Regional Center has authorized the work, including the service code, the authorized number of hours/units, and an end date.

5. Authorized Hours (Transition)

The initial 099 authorization is typically up to 40 hours. Where the participant meets DDS criteria (lack of natural supports, a preferred language other than English, or a higher level of need), additional hours may be requested from the IPP team on a case-by-case basis. Facilitator will notify the family before the authorized limit is reached so options can be discussed.

6. Client Responsibilities

Client agrees to participate in the planning process, provide accurate and complete information, respond to requests in a timely manner, and keep Facilitator informed of any changes affecting the participant's services, budget, or eligibility.

7. Confidentiality

Facilitator will keep the participant's information confidential and use it only to provide the services under this Agreement, except as required by law or authorized by Client.

8. Conflict of Interest Disclosure

Bravehope Partners and/or its affiliates may also offer Financial Management Services (FMS). Client understands that the choice of any service provider is the Client's free and independent choice and is not a condition of receiving these services.

9. No Legal, Financial, or Medical Advice

Facilitator provides facilitation and coordination services only and does not provide legal, financial, tax, or medical advice.

10. Limitation of Liability

Facilitator's total liability under this Agreement is limited to the fees paid by or on behalf of the participant for the services giving rise to the claim.

11. What Comes Next

Once services are active, families may continue with ongoing Independent Facilitation under a separate monthly service agreement.

12. Entire Agreement

This is the entire agreement between the parties regarding these services and may be amended only in writing signed by both parties.

Bravehope Partners will countersign this agreement on our end once received.