Program Overview

This application is for individuals seeking assistance with rent and utilities in the City of McKinney.

The Prevention Program helps families with children stay in their current housing during a temporary financial hardship. Assistance may include limited financial support, case management, and referrals to community resources. This program is only for families living in McKinney, TX. Funding is limited, and assistance is not guaranteed. Eligibility is determined through an application and review of documentation.

A photocopy or facsimile of this consent form will be considered as valid as the original.

 It is the policy of the Program to treat your records as confidential and not disclose them without your written authorization, except for certain disclosures permitted or required by law. This means that confidential information will not be shared (even with family or household members) without your authorization.

However, to provide all the services for which you are eligible, we require your authorization to release information to other participating agencies, entities, or individuals involved in delivering Program services to you. This information may be entered into a computer database accessible to other social service agencies. Access to Program services may depend on the Program’s ability to share information with these agencies, entities, or individuals.

AUTHORIZATION:

I understand that confidential information may be shared with the agencies, entities, or individuals checked below and that these agencies, entities, or individuals may also share confidential information with FPOCC for the purpose of providing program services. This authorization is valid for 60 days from the date of my signature.

Landlord/Private Owner
Utility Companies
The City of Irving
Mental Health Agencies
Independent School Districts (within Collin County)
Housing Agencies
Religious Organizations/Churches
Legal Aid of Northwest Texas
Medical Institutions
Financial Institutions
Social Services Agencies
Substance Abuse Assessments/History
State/Local Agencies
Homeless Shelters/Agencies
Domestic Violence Shelters
Employer (for employment verification only)

By signing below, I, the Applicant, authorize FPOCC to share confidential information with the agencies, entities, or persons identified above. I acknowledge that I may withdraw this authorization at any time in writing. Furthermore, I release the Program from all legal responsibility and liability that may arise from the actions authorized herein.