By signing this Release of Information you give consent to Millennia Ministries to share your information such as but not limited to the following:
- Your Name
- Current Location
- Phone Number
- Email
- Family Members Names (Spouse & Children)
- Agencies You Are Working With
- Income
- Rental History
- 211 History
The purpose of sharing this information is to assist in housing referrals, emergency shelters, rental assistance, utility assistance, and other assistance that you and your family may need. This information will be shared with other agencies that offer housing, shelter, rental & utility assistance, etc. At the time of sharing with agencies, you will be informed prior to the release of your information to any agency.
Please sign and date this document as your acknowledgment of authorization of the release of your information.
