| Privacy Notice |
| Emergency Fund Network Release of Information |
| The Emergency Fund Network is a group of agencies that work together to provide services to low-income individuals and families that live in St. Louis City, St. Louis County and St. Charles. This group includes shelter, housing, food, state, private and non-profit social service agencies, and faith group organizations. Authorization Form: I give the participating Emergency Fund Network agencies and their representatives, my permission to share some of all of the following information regarding my family and me. I understand that this information is for the purpose of assessing our needs for housing, utility assistance, food, counseling and/or services. The information may consist of the following: 1. My financial situation, to include the amount of my income and any savings of money and/or food stamps I may have. This information may also include debts I owe for utilities, rent, etc. 2. Physical or mental health problems, which may interfere with my ability to maintain shelter, housing, utility payments and/or care of my children. 3. Identifying and/or historical information regarding myself and member of my household. I understand that participating service providers will treat this information in a professional and confidential manner. Furthermore, I understand that the network members have signed an agreement to maintain confidentiality regarding summaries and team presentations. I further understand that the release of this information does not guarantee that assistance will be provided. Without theinformation my case CANNOT be presented to the Emergency Fund Network for consideration. This release of information remains in effect for a period of 1 year from the date of your signature, until revoked in writing. Service Providers Network Members: Adequate Housing for Missourians American Red Cross Ecumenical Housing Production Corporation Housing Resource Center Lutheran Family can Children's Services of Missouri Missouri Division of Family Services St. Louis Metro Baptist Association Presbytery of Gidding-Lovejoy St. Patrick Center Salvation Army CAASTLC Cardinal Ritter Institute United Way of Greater St. Louis Jewish Family and Children Services * This list my be added to as our membership may change |
| We collect personal information directly from you for reasons that are discussed in our privacy statement. We may be required to collect some personal infomation, by law or by organizations that give us money to operate this program. Other personal information,that we collect, is important to run our programs, to improve services for homeless persons, and to better understand the needs of homeless persons. We only collect information that we consider to be appropriate. You may request a copy of our full Privacy Notice. |
 |
| Website Designed by: http://www.geocities.com/undergroundwebdesign2006/page1.html |
| Funding made possible by: St. Louis City Affordable Housing Trust Fund, St. Louis City Department of Human Services, St. Louis County Department of Human Services, Missouri Housing Development Commission, United Way of Greater St. Louis-Emergency Food and Shelter Grant, Fox Family Foundation. |