2020-2021 Student Assent Form

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Welcome to Youth Guidance!

This web page provides detailed information you need to know before enrolling and assenting to participate in Youth Guidance programs.

Participating in this program will give you the chance to do fun activities with friends and learn new things that may help you in school. Youth Guidance program activities happen during school, before-school, after-school, or sometimes even during school vacations and summer. Youth Guidance programs are voluntary, so if you decide you do not want to participate anymore you can leave the program at any time.

IMPORTANT: You should only complete the Assent Form in this page if you are between the ages of 12 and 17 and wishing to participate in Youth Guidance programs.

Youth Participant Assent for Services

On this page are:

  • The Statement of Student Rights
  • The Service Appeal and Client Grievance Procedure. You may file a grievance or complaint if you feel you have been treated unfairly by Youth Guidance staff. You should bookmark this site so you can access the information if you ever need to use it

As a Youth Guidance program member, you are agreeing to:

  • Participate in the activities when you sign up for them
  • Make up any schoolwork you may miss if a session or activity is during class time
  • Respect yourself, your peers, your school, your Youth Guidance staff member, and your activity instructors
  • Adhere to the student code of conduct for your school district

At the Youth Guidance staff member’s request, you may be asked to leave this program in the following cases:

  • Lack of participation in the program
  • Violations of the district’s student code of conduct
  • Disrespect of others

The things you talk about with your Youth Guidance staff member will remain private, except:

  • if you have, are, or are planning to hurt yourself
  • if someone has, is, or is planning to hurt you
  • if you have, are, or are planning to hurt someone else
  • if your parent or guardian wants to give the information to someone else

Youth Guidance Program Assent Form

Service Appeal & Client Grievance Procedure

The information contained on this web page is specific to the Youth Guidance Service Appeal and Client Grievance Procedures for the State of Illinois. If your services are being provided in another state, please contact YG for the correct information for your state.

What can we do better for you?

Youth Guidance is committed to providing high-quality services to children, youth and families in schools and the community. The goal of these services is to support both academic achievement and social and life skill development. Youth Guidance trains and supports staff so that they understand the client’s needs and the role of staff in providing services. However, on occasion situations do occur when there are differences of opinion regarding services provided.

When these situations arise, you have the right to voice your concerns and to use Youth Guidance’s Service Appeal and/or Client Grievance Procedure to have those concerns addressed in a fair, reasonable and timely manner. Initiating a Service Appeal or registering a formal grievance will not affect your ability to receive services.

  1. Talk about your concerns with your Youth Guidance staff member. When a client feels that their concerns have not been addressed by the Youth Guidance staff member or you are uncomfortable discussing the matter with the Youth Guidance staff member, you should contact the Youth Guidance staff member’s supervisor/manager or a Youth Guidance Program Director. You can do so either by calling Youth Guidance or putting your service concern in writing and mailing it or emailing it to a Youth Guidance Program Director.
  2. Youth Guidance expects that a representative from Youth Guidance will meet with you within ten (10) working days to address your concerns. A record of the meeting and the outcome will be recorded, and a copy will be supplied to you. The written record of a grievance starts with this step.

What is a grievance? A grievance is any disagreement you may have with Youth Guidance about the type or quality of service you have received from Youth Guidance that cannot be successfully resolved through the appeal process described above.

  1. If you want to register a grievance about any aspect of Youth Guidance’s services, you should write down the grievance and send it to the Youth Guidance Program Director responsible for the applicable Youth Guidance program (to the extent applicable) with a copy to the Chief Program Officer.
  2. Youth Guidance expects that a Youth Guidance Director will meet with you within ten (10) working days of receipt by Youth Guidance of your written grievance.
  3. If the meeting does not resolve the situation, you will be requested to send a written grievance to the Chief Executive Officer (“CEO”) of Youth Guidance. We will provide assistance in completing this step if you would like.
  4. If a written grievance to the Youth Guidance CEO has not been received within thirty (30) days of your meeting with a Youth Guidance Director, a letter of closure will be sent to you by Youth Guidance.
  5. If a written grievance from you is received by the Youth Guidance CEO within thirty (30) days of your meeting with a Youth Guidance Director, Youth Guidance will send you a letter acknowledging receipt of the grievance and confirming a review of the situation will be undertaken by the Youth Guidance CEO.
  6. The Youth Guidance CEO’s assessment and final determination will be presented to you in writing within thirty (30) days of the date of the Youth Guidance grievance acknowledgement letter.
  7. The Youth Guidance CEO’s decision on the grievance is final (“Decision Notice”).
  8. A record of, and the response to, submitted grievances will be kept by Youth Guidance in accordance with applicable law.

You may also seek assistance from an independent advocate such as:

Illinois Guardianship & Advocacy Commission

If services are funded through the State of Illinois or another governmental agency, you have the right to contact the State of Illinois or the other governmental agency to review your grievance and how it was handled. The timeframe for obtaining a grievance review or appeal is limited and will vary based upon the governmental agency and type of services.

Typically, the timeframe to seek a review will start running from the date of the Decision Notice. If you are not satisfied with the Decision Notice you may contact the following agencies for further information about the process and timeframe for grievance reviews and appeals:

  • Illinois Dept of Human Services Bureau of Hearings 69 W. Washington Street, 4th Floor Chicago, IL 60602
  • Illinois Dept of Healthcare and Family Services Bureau of Managed Care 401 South Clinton Street, 6th Floor Chicago, IL 60607
  • Additional information may also be found at: http://www.illinois.gov/hfs

At Youth Guidance we believe that no matter what challenges young people face, they are more likely to succeed when they have caring adults in their lives. Our highly trained staff guides youth to overcome life and academic challenges so they can succeed in school and in life. Annually, Youth Guidance reaches more than 12,000 children and youth in approximately 110 Chicago Public Schools and has recently expanded programs to Chicago’s suburbs, Boston, MA and Los Angeles, CA.

Our programs include:

Youth Guidance is accredited by the Council on Accreditation (COA).