JUNE 18th HOMEOWNERSHIP EVENT

Participant Information

First Name *

Last Name *

Address 1

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County

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Would you be interested in receiving additional no- cost services offered by D&E? *

YES

Privacy Policy D&E, A Housing & Economic Empowerment Center, Inc. is committed to assuring the privacy of individuals and/or families who have contacted us for assistance. We realize that the concerns you bring to us are highly personal in nature. We assure you that all personal information shared orally and/or in writing will be managed within ethical and legal considerations. Your “nonpublic personal information,” such as your total debt information, income, living expenses and personal information concerning your financial circumstances, will be provided to creditors, program monitors, and others only with your authorization. We may also use anonymous aggregated case file information for the purpose of evaluating our services, gathering valuable research information, and designing future programs. What personal information does D&E collect about you? We collect personal information about you from the following sources: • Information that you provide on applications, forms, email, or verbally • Information about your transactions with us, our affiliates, or others • Information we receive from your creditors or employment references • Information we receive from a credit reporting agency, such as your credit history. What categories of information do we disclose and to whom? We may disclose the following personal information to financial service providers (such as companies providing home mortgages), Federal, State, and nonprofit partners for program review, monitoring, auditing, research, and/or oversight purposes, and/or any other pre-authorize individual and/or organization. The types of information we disclose are as follows: • Information you provide on applications/forms or other forms of communication. This information may include your name, address, Social Security Number, employer, occupation, account numbers, assets, expenses and income. • Information about your transactions with us, our affiliates, or others; such as your account balance, monthly payment, payment history, and method of payment. • Information we receive from a consumer credit reporting agency; such as your credit bureau; we do not sell or rent your personal information to any outside entity. • We may share anonymous, aggregated case file information; but this information may not disclose in any manner that would personally identify you in any way. This is done in order to evaluate our program, gather valuable research information, and/or design future programs. • We may also disclose personal information about you to third parties as permitted by law. How is your personal information secured? We restrict access to your nonpublic personal information to D&E employees who need to know that information in order to perform their housing counseling duties. We maintain physical, electronic, and procedural safeguards that comply with federal regulations to guard your nonpublic personal information; and we train our staff to safeguard client information and prevent unauthorized access, disclosure, or use. Opting Out of Certain Disclosures You may direct D&E to not disclose your nonpublic personal information to third parties (other than disclosures made to protect partners and those permitted by law). However, if you choose to opt-out, we will not be able to answer any questions from your creditors, which may limit D&E’s ability to provide services such as foreclosure prevention counseling or credit restoration counseling. If you choose to opt-out, please check the box next to the “Opt-Out” clause. If you choose to release your information as stipulated in Privacy Policy, check the box next to the “Release” clause. You may change your decision at any time by contacting our agency. RELEASE: I hereby authorize D&E to release nonpublic personal information it obtains about me to my creditors and any third parties necessary to provide me with the services I requested. I acknowledge that I have read and understood the above privacy practices and disclosures. I acknowledge that I have received a copy of the Privacy Policy. OPT-OUT: I request that D&E make no disclosures of my nonpublic personal information to third parties other than project partners and those permitted by law. By choosing this option, I understand that D&E will NOT be able to answer any questions from my creditors. I understand that I may change my decision at any time by contacting D&E. I acknowledge that I have received a copy of the Privacy Policy. *

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