Application for Assistance

On Your Feet Foundation provides two basic types of assistance:

Mentoring/Community Support: this includes retreats, closed Facebook groups, virtual support groups and other functions throughout the year;
Case Management: this encompasses assistance in establishing and supporting educational and career goals, budget planning and counseling.

Who Can Receive Case Management Support from On Your Feet Foundation?

Case management/community support is available to any birthparent in an open or closed adoption, in any state, and placed at any time.
Financial assistance is available to those who meet the following criteria:
- Completed the Case Management Application and spoken with a Case Manager.
- Working with an On Your Feet Case Manager and/or participating in On Your Feet retreats, virtual support calls or Facebook groups for a minimum of 4 months or 6 events (including support calls, in-person events, virtual retreats or in-person retreats).
- Retreat participants are eligible for grants to attend retreats and for post-retreat counseling. Currently, our retreats are only offered to birthmothers.
- In order to qualify, you must:
  - Demonstrate financial or emotional need
    - Supporting documentation may be required
  - Present a realistic plan for self-sufficiency and personal growth
  - Demonstrate thoughtful consideration of financial needs and opportunities
  - Seek opportunities for supports available through educational institutions and other resources
  - Set goals that are realistic and attainable to move continually toward self-sufficiency
  - Establish a reasonable time frame and request appropriate support over time in their application

Who can apply to On Your Feet Foundation?

To maintain privacy, applications must be from:

A Birthparent Support Alliance Member Agency, Attorney or Organization
The birthparent applicant
The birthparent’s parent or legal guardian

What Type of Assistance Do You Provide?

All birthparents enrolled in the program will have a case manager working to network services and find strategies that are long-term and comprehensive.
Financial assistance may be provided for school and school-related expenses, interim job-related expenses, such as transportation or child care, and short-term counseling that is not covered by insurance.
Applicants are encouraged to identify other needs in addition to the above for consideration by the On Your Feet Foundation. The list above is an example of the types of assistance that will be considered, but you may have a unique need that will be considered.

Are There Any Types of Requests You Do Not Grant?

Funds are not intended for crisis or emergency assistance including emergency rent, past due bills/old debt or car repairs/purchases.
Funds may not be used for expenses related to pregnancy or adoption.
Funds are not intended to replace funds from ongoing programs such as Medicaid, Section 8 housing assistance, food stamps, or financial aid/FAFSA/scholarships, but rather to be an interim or supplemental source of assistance.
On Your Feet may choose to deny grant requests that involve tuition being paid to for-profit institutions.

How Much Assistance Do You Provide?

Grants are evaluated on a case-by-case basis. The average grant award is <$1,000.

How Are Assistance Decisions Made?

On Your Feet Foundation makes decisions based on the financial and emotional needs of the applicant.
The Foundation reviews a completed application and awards grants on an as-needed basis.

How Long Does It Take To Get Assistance?

Applicants will be notified within two weeks of submitting a completed application and having an interview with a case manager from On Your Feet Foundation.

Who Receives the Funds?

Similar to adoption assistance, funds will be disbursed to the organization actually providing the services to you. For example, test-taking fees would be sent, on your behalf, by On Your Feet Foundation to the test provider; GED fees would be remitted, on your behalf, to the institution.

Where do I return the application when completed?

Applications can be completed on our website. If you are unable to complete the application online, please contact Jennifer Adams, Director of Case Management, at 773-273-9645

Case Management Application

Personal Information

Your Name

First Name *

Last Name *

Address

Country

Address Line 1 *

City *

State/Province *

Postal Code *

Email (Required)

Phone (Required)

Date of Birth (Required)

What is your date of birth?

Demographic Information

Race/Ethnicity (Please check all that apply):

Black/African American
Hispanic/Latino
Asian
Native Hawaiian/Other Pacific Islander
Indigenous Peoples/First Nations/Inupiaq/Inuit
White/Caucasian
Other/Prefer Not To Say

If Other, please indicate:

What are your pronouns:

She/Her
He/Him
They/Them
Other (Please tell us in the space provided)
I prefer not to say

What are your pronouns, if not included in the options above:

What is the highest level of education you have completed?

Marital Status

Single/Never Married
Married/Partner
Separated
Divorced
Widowed
Other/Prefer not to say

Are you eligible for Medicaid or Government Assistance??

Information About Your Placement

What is the date of birth of the child you placed for adoption? (Required)

What is the date of birth of the child you placed for adoption?

When did you place your child for adoption? (Required)

When did you place your child for adoption?

Which Adoption Agency or Attorney handled the adoption? (Required)

(Name of Agency/Attorney/DCFS/Foster, Contact Name, Phone/Email)

Did you place in a transracial adoption?

Yes
No
Unsure

Did you place in a kinship adoption?

Please select the option that best describes your adoption presently:

Open
Semi-Open
Closed
In Reunion

Where does the child you placed/their adoptive family currently reside? (City, State or Unsure) (Required)

Please describe your relationship, if any, with your child and his/her adoptive family (Required)

Is there anything else you would like to tell us about your adoption?

Request for Services

When did you learn about On Your Feet Foundation?

Within the last week
+1 week - 6 months ago
+6 months - 1 year ago
+1-3 years ago
More than 3 years ago

How did you hear about On Your Feet Foundation?

Birthparent Support Alliance Member
Non-Alliance Agency or Attorney
Another Birthparent
Internet Search
Other

What are you hoping to get out of working with On Your Feet Foundation? (Required)

Please be as detailed as possible.

Are you interested in any of the following? Please select yes or no.

Connecting with other birthparents

Yes
No
Not sure

Locating birthparent support groups

Yes
No
Not sure

Attending birthparent events

Yes
No
Not sure

Learning more about On Your Feet Birthmom Retreats

Yes
No
Not sure

Finding counseling/therapy services

Yes
No
Not sure

Learning more about On Your Feet grants

Yes
No
Not sure

Learning about substance abuse programs

Client's Rights & 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 On Your Feet Foundation, that your experience will be productive and beneficial to you, and that you will be successful in attaining your goals.

As an On Your Feet 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 On Your Feet staff will work together to provide support that best fits your needs.

5. Work together with On Your Feet 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 On Your Feet to apply eligibility criteria fairly and impartially.

11. Receive service at times mutually convenient to you and On Your Feet staff during customary business hours (Weekdays from 8am-5pm CST) or by appointment on evenings and weekends. On Your Feet 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 On Your Feet’s Executive Director.

As an On Your Feet 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 On Your Feet programs and services as well as notifying On Your Feet 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 On Your Feet staff’s 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 On Your Feet’s programs and services wisely and not wasting resources.

4. Not discriminating against On Your Feet staff or clients on the basis of race, religion, gender identity, or sexual orientation.

5. Communicating with On Your Feet 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 On Your Feet staff and clients by listening to others when you are participating in any of On Your Feet’s support calls, events, retreats, and engaging in our social media pages or groups.

7. Maintaining the confidentiality of other On Your Feet clients when participating in any On Your Feet 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 On Your Feet 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 On Your Feet’s support calls, events, retreats, and engaging in our social media pages or groups.

On Your Feet 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 On Your Feet programs when services have been paused or terminated.

4. Mute or remove a client from On Your Feet 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.

Acknowledgement of Clients Rights & Responsibilities:

All three boxes must be checked.

I have read and understand the above Rights and Responsibilities and agree to abide by them.
I understand that these Rights and Responsibilities exist so that I may receive the best possible care in order to meet my goals.
I also understand that failure to abide by these Rights and Responsibilities may result in termination of services.

Consent and Release of Information

This release does three basic things:

1. It gives us permission to contact your agency

2. It allows us to use your non-identifying information in our statistical analysis to evaluate the effectiveness of our services

3. It enables us to collaborate as a team to provide the best services to you

I, name entered below, give permission to On Your Feet Foundation to exchange or release information regarding adoption services. I also give permission for On Your Feet Foundation to contact references and the adoption agency that provided services during pregnancy and placement.

I am aware that On Your Feet Foundation 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 On Your Feet may use parts of my story in printed materials and/or website/social media pages. I understand that On Your Feet Foundation will never share confidential or identifying information about me such as photos, names or contact information without my express, written consent and that On Your Feet Foundation will seek my permission prior to sharing anything related to my story.

By signing this release, I understand this allows all pertinent On Your Feet Foundation personnel/staff to collaborate on my behalf as a team, to provide the best services deserved to me.

Signature

First Name *

Last Name *

wndv3apbjqxc

Date (Required)