Limits of Confidentiality

I hereby authorize the Los Angeles LGBT Center (The Center) to provide and allow services
that are necessary for a case plan. I further give consent for the Center to collect and release any information
considered necessary for effective client service, to other departments of the Center or other agencies working with
me. In addition, I give consent to release data to the Youth Services Department funding sources for program
evaluation and for research, as long as it shall be held confidential and maintained anonymously.

All information that members share with Youth Services staff is held in confidence with the following exceptions:

 I.  All information regarding the physical and mental health, well-being and safety of a member may be shared
between the Youth Services staff that are participating in providing services to the member. This includes
management staff and administration staff.

 II.  If you provide information that indicates you are at risk of harm to yourself or others, this information may be
shared with other appropriate agencies or individuals.

 III.  If you are a minor and report that you were or are at risk of being sexually or physically abused, and/or
neglected, we are mandated by law to report this to the Los Angeles Department of Children and Family
Services (DCFS).

 IV.  If you disclose information that leads staff to suspect that any minors are in danger, are being abused, and/or
neglected, we are mandated by law to report this to DCFS.

 V.  If you disclose information that leads staff to suspect that any elderly or dependent adult are in danger, are
being abused, and/or neglected, we are mandated by law to report this to the authorities.

 VI.  If the police come to the building and wish to speak to you as part of an investigation, we are required by law
to answer truthfully.

 VII.  When referring you to other agencies or individuals for services, we will give out only that information which
is required by those agencies or individuals to adequately provide you with services

Policy on Non-Discrimination in Services

NONDISCRIMINATION IN SERVICES: Contractor shall not discriminate in the provision of services here under because of race, color, religion, national origin, ethnic group identification, ancestry, sex, age, condition of physical or mental handicap (as defined in 41 CFR 60-741.2), in accordance with requirements of Federal and State laws, or in any manner on the basis of the client’s sexual preference. For the purpose of this Paragraph, discrimination in the provision of services may include, but is not limited to, the following: denying any person any service, or benefit to any person which is not equivalent, or is provided in a nonequivalent manner or at a non equivalent time, from that provided to others; subjecting any person to segregation or separate treatment in any manner related to the receipt of any services; restricting any person in any way in the enjoyment of any advantage or privilege enjoyed by others receiving any service or benefit; and treating any person differently from others in determining admission, enrollment quota, eligibility, membership; or any other requirements or conditions which persons must meet in order to be provided any service or benefit. Contractor shall take affirmative action to ensure that intended beneficiaries of this Agreement are provided services without regard to race, color, religion, national origin, ethnic group identification, ancestry, sex, age, condition of physical or mental handicap, or sexual preference.

Facility access for handicapped must comply with Rehabilitation Act of 1973, Section 504, where Federal funds are involved.

Contractor shall further establish and maintain written procedures under which any person, applying for or receiving services here under, may seek resolution from Contractor of a complaint with respect to any alleged discrimination in the provision of services by Contractors’ personnel. Such procedures shall also include a provision whereby any such person, who is dissatisfied with Contractor’s resolution of the manner, shall be referred by Contractor to Director, or his authorized designee, for the purpose of presenting his or her complaint of alleged discrimination. Such procedures shall also indicate that if such person is not satisfied with County’s resolution or decision with respect to the complaint of alleged discrimination, he or she may appeal the matter to the State Department of Alcohol and Drug Programs. At the time any person applies for services under this Agreement, he/she shall be advised by Contractor of these procedures.

A copy of such nondiscrimination in services policy and appeals procedures, as identified herein above, shall be posted by Contractor in a conspicuous place, available and open to the public, in each of Contractor’s facilities where services are provided here under.

Youth Center Mail Service Policy

The LGBT Youth Center and Residential Programs offers mail as a service. While the LGBT Center is attentive to this service delivery, we do not accept responsibility for lost or misplaced mail. If we have reason to believe that you have used our address in any illegal/fraudulent way, you will lose your access to this service.

How it works:

 1.  We file mail by your first name. Please ask the staff for any assistance with this service. If you are not comfortable with stating your name in public, please ask staff for a pen and paper to write it down

 2.  It is your responsibility to check your mail on a regular basis

 3.  Drop-in program in mail service hours are from 9am-12pm and 2pm-3pm Monday-Friday and 11am-1:30pm Saturday and Sunday. We return unclaimed mail to the Post Office every 30 days.
    - If you are expecting any documents (ID, birth certificate, social security card) please specify as our Youth Care Specialist team will hold on to these items longer.

 4.  You, and only you, can pick up your mail that is addressed to the name we know you as. This is in accordance with the law. While exceptions may be made, it involves a conversation in order to obtain verbal or written consent and only under certain circumstances. Please plan with a staff member.

 5.  Please use this mailing address:

     Your name
     Youth Center
     1118 North McCadden Place
     Los Angeles, CA 90038

 6.  All packages must be pre-approved by a staff person prior to their delivery. If a package arrives that has not been authorized, it may NOT be accepted

 7.  If you choose to use this address for your State ID or for any other matter that is public information, you waive your rights to confidentiality.
    - (For example, a police officer comes here with a copy of your ID that has this address on it and asks if you use services here, we will say yes.)

 8.  If you wish to use this address for Probation or Parole, you must first talk to a case manager to discuss consents, confidentiality, and what it means to the agency and every youth who accesses services at the Youth Center. When this address is on file, probation and parole officers have the right to come inside whenever they want. While we may be able to work with this, we need to discuss it with your officer first.

 9.  When you turn 25 and graduate from LGBT Youth Services, we can no longer provide this service. Please make note of this and prepare for it. You will not be able to submit a change of address request. You will need to contact all the people/companies directly, who send you mail and update them with your new address. DO NOT MAKE THE CHANGE AT THE POST OFFICE. Aged out youth have the option to access services at The Center at Blessed Sacrament and use their address for mail services. You may send your mail to Blessed Sacrament Social Services, 6636 Selma Ave, Los Angeles, CA 90028.

 10.  As always, please ask staff if you have any questions or suggestions.

Community Safety Agreement

The Youth Center is part of the Hollywood Community. I understand that the Youth Center is dedicated to being a productive and supportive part of our community. As a Community Member, I agree to the following:

 - I will be respectful to the community, its members, and businesses.
 - I will help maintain cleanliness by removing all personal belongings.
 - I will prioritize the safety of myself, my peers, and Youth Center staff by refraining from buying, using, distributing and/or selling drugs and alcohol within a 4-block radius of the Los Angeles LGBT Center AMR Campus.
 - I will uphold community values by refraining from vandalizing or damaging any businesses, residences, or organizations.