This release allows MCCAC to share with those listed below minimal information needed for assisting your household with any of the following: Attaining and keeping permanent housing; attaining temporary emergency housing; attaining and keeping needed utilities as part of housing stabilization; advocacy and funding on your behalf with any of a variety of entities, depending upon your needs; partnering with additional agencies in the local continuum, to best serve you and other household members.
PLEASE NOTE: Your paper file might be viewed in whole or part by our funding source (OHCS) on dates past the 1-year end date of this notice. Furthermore, any electronic data entered into Service Point (the Homelessness Management Information System) with regard to your participation in MCCAC's housing programs might be viewed for up to 7 years following your exit date from our program(s). By signing below, you acknowledge the following:
I understand that my record may have information that is protected by Federal and State law and I allow such information to be given out to other persons (ONLY as listed below) or agencies involved in my life, ONLY WHEN SUCH ENCHANGE IS NEEDED TO ASSESS AND MAKE ME ELIGIBLE FOR SERVICES AND FUNDS, AS DETERMINED BY MY ASSISTANCE PLAN WITH MID-COLUMBIA COMMUNITY ACTION COUNCIL INC. AND MCCAC'S FUNDING REQUIREMENTS.
I acknowledge that I have the right to change the time period for which this release is valid (below) with regard to people or agencies other than Oregon Housing and Community Services and the Rural Oregon Continuum of Care, and I can cancel this ROI at any time without it affecting my services. I also have a right to a copy of this release.
With the exception of Oregon Housing and Community Services and the Oregon Continuum of Care, this release of information begins on date of signature and ends on date one year from today's date.
Agencies (or people) with whom I will allow you to share information, in order to best serve my needs:
1. Connect Oregon (Unite Us) Intake Referral Platform (good for 1 year from date of signature)
2. Oregon Housing and Community Services (up to 7 years from the last date of service/date of this ROI)
3. Rural Oregon Continuum of Care (up to 7 years from the last date of service/date of this ROI service)
4. Other MCCAC Programs (i.e. Energy Assistance, Supportive Services for Veteran Families, etc
5. If applicable: Mid-Columbia Housing Authority, Bridges to Health Pathways Program/Columbia Gorge Health Council, Bridges to Change, Columbia Gorge Community College, Columbia Gorge Education Service District, Columbia Gorge Food Bank, ColumbiaCare Greater Oregon Behavioral Health, Inc., HAVEN from Domestic Violence, Helping Hands Against Violence, Mid- Columbia Children's Council, Mid-Columbia Center for Living, Mid-Columbia Medical Center, Providence Hood River Memorial Hospital and Better Outcomes thru Bridges Programs, Mid-Columbia Economic Development District, Nch'i Wana Housing, North Central Public Health District, One Community Health, Oregon Department of Human Services, Oregon Eviction Defense Project, Oregon Human Development Corporation, PacificSource, Six Rivers Dispute Resolution Center, St. Vincent de Paul of The Dalles, The Next Door, Inc., Wings, Youth Empowerment Shelter, and/or YouthThink.