THIS SIGNED FORM IS THE AUTHORITY by which I consent to the exchange of personal information between Catholic Charities and other relevant agencies/businesses.

The information exchanged will be used for professional purposes only. It includes information such as name, address, telephone number, and utility account number pertaining to a person’s request or assistance for rent, utilities, and/or car repair from the respective landlord, utility company, and/or car repair company which has been given, as well as any other information deemed important for the delivery of services.