Disclaimer and signature: I hereby authorize the release of information to Cornerstone Christian Church to receive assistance I am requesting. I further certify the information I have provided is true and correct and that all income has been reported. I understand that Cornerstone may verify the information on the application and any deliberate misrepresentation of information will be subject to denial of assistance and services. I authorize Cornerstone to discuss my case with other agencies, businesses, churches, attorneys, individuals or others deemed necessary to verify the accuracy of information and/or identify additional sources of assistance. I understand that all information will remain as confidential as possible within these entities.
I have read, understand and agree to the policies above regarding the Release of Information.