HOPE PROGRAM INTAKE FORM

https://www.lisc.org/san-diego/homebuyers/hope/

Urban League of San Diego County collects personal information about the people we serve in a computer system CounselorMAX (CMAX). We collect and maintain client information in a private and secure computer system. People who work for ULSDC will use this information to help provide and track services for you or your family. This information may be shared with auditors or others who have legal rights to review the work of this agency, including private and public funders. All employees using the CMAX system must sign an agreement to protect your privacy before seeing any client information. Your private identifying information will never appear in reports.

I understand that information about services provided to me may be used to conduct research and reporting, related to service needs, income supports, education and employment, and program effectiveness. The use of this information for research and reporting may last beyond the actual delivery of current services. My name, social security number or other information that would identify me personally will never appear on research or a report. I also understand that my phone number, email or address may be used by ULSDC to contact me about upcoming classes or regarding my progress toward my goals. ULSDC will always provide a method to opt out of calls or emails. My signature shows that I permit you to enter my personal information into CMAX and receive periodic contact from ULSDC via phone or email, with the option to opt out.

I grant to ULSDC, its representatives and employees the right to take photographs of me and my property in connection with the workshop subject. I authorize ULSDC, its assigns and transferees to copyright, use and publish the same in print and/or electronically. I agree that ULSDC may use such photographs of me with or without my name and for any lawful purpose, including for example such purposes as publicity, illustration, advertising, and web content.

I certify that I have reviewed all disclosures on this page with the client whose signature appears above and have answered all questions the client has had regarding the content of these disclosure.

We at Urban League of San Diego County committed to assuring the privacy of individuals and/or families who have contacted us for assistance. We realize that the concerns you bring to us are highly personal in nature. We assure you that all information shared both orally and in writing will be managed within legal and ethical considerations. Your “nonpublic personal information,” such as your total debt information, income, living expenses and personal information concerning your financial circumstances, will be provided to creditors, program monitors, and others only with your authorization and signature on the second page of this form. We may also use anonymous aggregated case file information for the purpose of evaluating our services, gathering valuable research information and designing future programs.

Information We Collect

We collect personal information to support our Housing and Financial Capabilities operations and to aid you in shopping for a home mortgage or sustaining your home mortgage or attaining housing stability. We collect personal information about you from the following sources:

·       Information we receive from you orally, on applications or other forms, such as your name, address, social security number, date of birth, employer, occupation, assets, debts and income; and

·       Information about your transactions with us, your creditors, our affiliates or others, such as your account balance, payment history, parties to your transactions and credit card usage; and

·       Information we receive from a credit reporting agency, such as your credit bureau reports, your credit history and your creditworthiness.

Information We May Disclose
We may disclose the following kinds of personal information about you:

·       Information that we receive from you on intake or other forms, never date of birth, name nor social security;

·       Information about your transactions with us, our affiliates or others,

·       Information we receive from a consumer reporting agency, and

·       Information that we receive from personal and employment references.

To Whom Do We Disclose

So long as you have not opted-out, we may disclose some or all of your personal information that we collect to the following types of unaffiliated third parties:

·       Financial service providers, such as companies engaged in providing home mortgage or home equity loans,

·       To your creditors or third parties where we have determined that it would be helpful to you, would aid us in counseling/coaching you to reach your housing goal, or is a requirement of grant awards which make our no cost services possible to your community.

·       We may also disclose any nonpublic personal information about you or former customers to anyone as permitted by law (e.g., if we are compelled by legal process).

·       Others, such as nonprofit organizations involved in community development, but only for program review, auditing, research and oversight purposes.

Prior to sharing personal information with unaffiliated third parties, except as described in this policy, we will give you an opportunity to direct that such information not be disclosed.

 

Confidentiality and Security
We restrict access to personal information about you to only those employees who need to know that information to provide products and services to you and to help them do their jobs, including underwriting and servicing of loans, making loan decisions, aiding you in obtaining loans from others, and financial & housing counseling. We maintain physical and electronic security procedures to safeguard the confidentiality and integrity of personal information in our possession and to guard against unauthorized access. We use locked files, user authentication and detection software to protect your information. Our safeguards comply with federal regulations to guard your personal information.

 

You may opt-out of certain disclosures

1. You have the opportunity to “opt-out” of disclosures of your nonpublic personal information to third parties (such as your creditors), that is, direct us not to make those disclosures.

2. You may opt-out of this requirement, but proof of your decision to opt-out must be recorded in your client file. 3

. If you choose to “opt-out”, we will not be able to answer questions from your creditors. If at any time, you wish to change your decision with regard to your “opt-out”, you may call us at 619-266-6276 and do so.

If you have ‘opt-out’ above, Please mail this form in a stamped envelope to:

Urban League of San Diego County 4305 University Avenue, Suite 360, San Diego, CA 92105 housing@sdul.org

Please allow approximately 30 days from our receipt of your Privacy Choices Form for it to become effective. Your privacy instructions and any previous privacy instructions will remain in effect until you request a change.

Urban League of San Diego County 4305 University Avenue, Suite 360, San Diego, CA 92105 housing@sdul.org

Front Desk: 619.266.6237 Dept Desk: 619‐266‐6256 Fax: 619.528.0054

Please sign below: the HUD counselor will prepare an Action Plan for you and email you copy