Blessings Program

Client Consent and Release of Information

1. Assessing the needs of low income, homeless or other people with special needs in order to get better assistance, and to improve their current or future situations
2. Improving the quality of care and service for people in need.
3. Tracking the effectiveness of community efforts to meet the needs of people who have received assistance.
4. Reporting data on an aggregate level that does not identify specific people or their personal information.
I understand that:
All agencies will treat my information in a professional and confidential manner. Signing this release form does not guarantee that I will receive assistance.
My information may be shared with a third-party, (utility provider, landlord, etc.) to process the services I have requested.
I have the right to a printed copy of my information on file.