Form Center

By signing in or creating an account, some fields will auto-populate with your information and your submitted forms will be saved and accessible to you.

Project RESTORE Agreement Signature

  1. Project RESTORE - PARTICIPATION AGREEMENT & CONSENT FOR SERVICES

  2. The youth has been determined to be eligible for a pre-referral diversion program, Project Restore. This program will hold youth accountable for their behavior through restorative justice practices and encourage behavior change through interventions and referrals to appropriate programs. The ultimate goal of Project Restore is to avoid youth having unnecessary entry into the justice system. This is a voluntary program. If participation is declined, then LPD and the County Attorney’s office will be notified.

  3. To successfully complete the program, the youth will have 4 in person meetings with the Case Manager within 60 days of the offense date. The youth will also have to complete restorative justice activities as outlined by a diversion plan developed by the Case Manager after the first meeting.

  4. In addition to the program requirements of Project Restore, data will be collected to evaluate the effectiveness of Project Restore. That data will include demographic data on you and any victims of the incident, the incident you were involved in at your school, the victim of that incident, and any further incidents that you are involved in over the course of the next 2 years. This data will not include as part of the evaluation of the project any individual identifying information and any analyses or reports that are generated from this data will not identify you or your victim.

  5. Any data obtained during this study which could identify you will be kept strictly confidential by the Project Restore Program Manager.

  6. By participating in this program you also consent to have Lincoln Public Schools share information with the Project Restore Program Manager regarding the discipline consequences for the incident which led the youth to be in this program.

  7. Your signature certifies that you have decided to participate having read and understood the information presented.

  8. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your agreement will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

  9. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your agreement will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

  10. Leave This Blank:

  11. This field is not part of the form submission.