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ContracvGrant Agreement Checklist
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Memorandum of Agreement
‘This Agreement Is ertered betwoen St. Glanna’s Matomity Home (Agency Provider),
‘Tha Vilage Family Servica Cantar and the North Dakola Department of Human.
‘Servocs {NDDHS).
NDDHS is reeponslble for superdsion of he Attomatives to Abotton Program. The
Vilage Farily Service Cantar wil administor the Atematives to Abortion Program
including macketing, updating and roaintalning a list ofsurice providers, making
payments to service providers and 1-800 service.
‘Tha programa wil provide postive cuscome-based information, counseling, and support
sarces with ne folowing requiremanis and expectations:
+L. Ptovlde somes to pragrent women ¢f women wo bebave they may be
ppragnart, vito reside in Nezth Dakota
2. Promate ctldolrih trough informaton, counseling anc educetlon to aselst
pragant women ta choose chido,
3, Asal! women in maklag Informed decialons about adoption or parenting with
reapact to the child.
Atematves to Abortion sentces dorot include medical sendces.
“Tha Agony Provider desires to provide Aterratis 49 Aborton sardces consistent with
the requirements of tia Aterraives to Abortions Program end to mast the raqulremants
OENDIC.C. § 50-06-28 and his Agreement. The Agency Provider agress to:
1, Scresn each potertal clent to establish thet sho ls prognart or reasonably
bafeves sha may be pregnant,
2. form each ollent thal It is her right to secure Altamatives to Abortions services
{fom a provider of thase sorvves lstad inthe Aarnatives to Abortions brochure;
3, AseistNDDHS and The Vilage Family Sores Conter in gathering dala t
evaluate the Allematves to Abortions Program fom the ctent's frst visit theugh
birth ofthe cfild,
4. Keap confidential the communications between a child and provdar or its
employees and agents, except 2s pemnittad by!ay or by he Informed agreement
of the ollont,
5, Submit tg NODHS ard The Vilage Family Service Cantar a copy of providers
Tabilty insurance policy for approval before requesting payment, end
6, Maintain approved lablEty coverage In effect at all times services are being
provided under this Agraamant.
Agency Provider agraes nat to:
4. Cousot for, refer for, eneaurage. or perform akorions, or knowingly refer an
Altematives to Abortions alent a another person or agency for tha purpose of
receiving counseling far, feral fer, oncouragement for, or te performance of
‘an abortcn; or
2, Diserlminate against Altematives to Abortions client on the basis of raligton, &
religious ballet, a refusal t hold a religious betel, or a refusal t acively
particlpate in @ religious practice.
Provider fot Alamatives ta Aborions eontces will recelve relmbursement for servic
provided based ana rata of §10.00 for each quarter Hour of service furished by &
member ofthe cirgy a nures Eoorsed under N.0.C.C. ch. 43-1224, apysician
llconsed under N.D.C.C. of. 49-17. a paychologist Hoensad under N.D.C.C. of, 432, a
soclal worker Icensed under N.D.C.C. ch. 43-41, an addicion counselor Sconsed under
ND.C.C, ch 43-48, a counselor linsed urder D.C. ch, 43-47, or a mantage ard
family therapist oansed under ND.C.<. ch. 43-53; and al acts of $5.00 for wach
quarter hour ofsorvie fumished by any otter Individual
“This Agrasmont Is afeotve July 2017 and remains In effect unt! June 30,2019, unlass
terminated by the Agency Provider, The Vilage Family Service Center of NDOHS.
‘This Agrooment may be terminated al any timo by mutual concont of parties, or upon
30-daya’ wnitien natioe by ether pany with or vilhout cause, Fallure by the Agency
Provider fo perforn the torms of fis Agraament may resuf in the immedlais tonrination
of fa Agreament,
Agony Provdor,__St Giaava's Matomly Home
Signature: Leh Gb Date_4 27/7
Tho Vitoge Family Serice Canter
gx tdv~w Dato: eva
155i Vang, PreadaniGEO
“Tre Vitae Parl Sorc Center
:Carol Cartedge, Director
‘Roonomie Astistance Policy OhslonNorth Dakota Department of Human Services
