TCBIN NEXT LEVEL LIVING COMMUNITY

In Partnership with Ministry of Compassion

The Comeback Initiative Network Re-Entry Workforce & Leadership Development Inc.

Participant Intake, Administration, and Residence Payment Agreement

This agreement is completed after acceptance and before move-in.

Participant Information

Participant Full Legal Name—

DC Number—

Release Date—

Expected Move-In Date—

Facility / Institution—

Employment Start Date—

Employer—

Current Pay Frequency—

1. Mandatory Intake and Administration Fee

$279.00 — Due after acceptance and before move-in.

This fee supports intake processing, program enrollment, initial paperwork, move-in coordination, arrival assistance, basic food and immediate-needs coordination, and initial case planning and referrals. It is separate from monthly residence payments and is not a security deposit.

Payment Status

Paid in FullApproved Written Payment ArrangementPending

Amount Paid Today ($)—

Remaining Balance ($)—

Payment Date—

Approved Due Date—

2. Residence Admission Payment

$850.00 Residence Admission Payment

Participants employed 30 days or longer are expected to pay the full $850.00 before move-in. Participants employed for less than 30 days are expected to pay the mandatory $279.00 intake fee and at least one-half of the residence admission payment ($425.00) before move-in, with the remaining $425.00 due under a written payment schedule. Any delayed, reduced, or divided payment must be approved in writing by authorized program leadership before move-in.

Participant Payment Category

Employed 30 days or more — $850 due before move-inEmployed less than 30 days — $279 intake fee plus $425 minimum before move-inUnemployed / verified hardship — written plan required

Residence Amount Paid Today ($)—

Residence Balance ($)—

Next Payment Amount ($)—

Next Payment Due Date—

3. Monthly Residence Payment Information — Ministry of Compassion Inc.

Monthly residence payments are made to Ministry of Compassion Inc. unless written instructions state otherwise. The participant must include their full name and payment month in the payment memo.

Recipient	Ministry of Compassion Inc.
Bank	Wells Fargo
Account Number	7904281206
Zelle	Minofcompass@gmail.com
Payment Purpose	Monthly residence payment

4. Intake / Administration Fee Payment — The Comeback Initiative Network LLC

The $279.00 intake and administration fee is paid to The Comeback Initiative Network LLC. The participant must include their full name in the payment memo.

Recipient	The Comeback Initiative Network LLC
ACH Account Number	1100042018188
ACH Routing Number	263191387
Cash App	$mjtcbinetwork
Zelle / Apple Pay	407-757-7029
Payment Purpose	Intake and administration fee

5. Participant Acknowledgment

I understand that acceptance into the program does not eliminate my responsibility to pay approved intake, admission, and residence charges.

I understand that participants with available employment income or other financial resources are expected to contribute toward program and residence costs.

I understand that no verbal promise changes this agreement. Any exception or payment modification must be written and approved by authorized leadership.

I agree to keep receipts or electronic payment confirmations and provide proof of payment when requested.

I understand that failure to follow an approved payment arrangement may affect continued program participation, and subject to program review and applicable law.

6. Signatures

Participant Printed Name—

Date—

Participant Signature—

Phone Number—

TCBIN RepresentativeMJ Evans

Date—

Ministry of Compassion Representative—

Date—

Participant must receive a completed copy of this agreement and a receipt for every payment.