Provider Application | Center for Hope WNY

By checking the boxes below, you agree to meet the obligations and expectations of the Center for Hope, WNY affiliated providers.

All affiliated providers shall follow the confidentiality rules both inherent in their own profession and inherent in the expectation of privacy of all Center for Hope, WNY clients. All information regarding our clients should remain confidential.

All affiliated providers shall conduct themselves within the ethics and expectations of their own professions.

When appearing or representing oneself as a Center for Hope, WNY affiliated provider in a public space whether in person or virtually, all providers shall maintain professional decorum.

All affiliated providers should be aware of and recognize that we are working with trauma victims. All our efforts shall be compassionate and empathetic in that pursuit.

No affiliated provider shall use the Center for Hope, WNY to advance their own personal, political, or religious agenda. Center for Hope, WNY is a non-partisan, non-religious not for profit organization. Failure to abide by this provision is grounds for immediate severance of the relationship between an affiliated provider and the Center for Hope, WNY.

All affiliated providers agree to offer a one time, no cost consultation regarding your area of expertise to all Center for Hope, WNY referrals. Should a client retain your services or otherwise hire you in any capacity after the referral is made, the affiliated provider shall release the Center for Hope, WNY from any and all liability or responsibility, legal or otherwise, should the client retain your professional services.

Once a provider receives a referral through the Center for Hope, WNY all affiliated providers shall make client contact whether by email or phone within 48 hours of the referral being made.

All providers shall utilize the CFHWNY portal to update information regarding referrals made to you. This is so we can track referrals and use client information for grant purposes. You will receive a log-in and password and instructions how to use the portal once your application is accepted.

By submitting this form I swear and certify that all of the information provided on this form and application is true, complete and accurate. I also understand and agree that any false, incomplete or inaccurate information may result in rejection as a prospective Provider or, if discovered subsequent to becoming a Provider, will result in my immediate removal as a Provider for the Center for Hope, WNY.