Creative Housing requests the cooperation of Tenants in efforts to provide and sustain a safe, affordable and inclusive living environment. Authorization granted can be revoked by Tenant in writing at any time and authorization granted is valid for only the duration of Tenant’s residency with Creative Housing.

Energy and Safety

At varying times, local/regional area organizations, local governments and utility companies offer home energy efficiency and safety services at no cost to income-eligible residents to help keep them warmer in the winter and cooler in the summer, all while lowering energy bills. Creative Housing works with these organizations to complete applications on behalf of Tenants, with which Tenant personal and financial information must be provided.

By signing, I hereby authorize Creative Housing to release information including my name, address, date of birth, Social Security Number and income verification documents, limited to that information which is necessary to establish my eligibility to benefit from energy and safety programs administered by local/regional area organizations, local governments and utility companies.

Tenant Signature Guardian of ☐Person ☐Estate ☐Limited Signature

     

Tenant Name & Date

Safety and Inclusiveness

Tenant-specific accommodations or modifications may be needed to provide appropriate community housing which is safe, promotes independence, and supports continuum of care. Creative Housing may need to communicate with Tenant’s supports, including Franklin County Board of Developmental Disabilities, HCBS Waiver Providers, family and advocates to accommodate individual needs.

By signing, I hereby authorize Creative Housing to obtain personal information, including the nature physical, mental/emotional and behavioral needs from my supports. This information may be disclosed to Creative Housing business partners providing services on my behalf and may not be disclosed otherwise without my permission, unless permitted by law.

Tenant Signature Guardian of ☐Person ☐Estate ☐Limited Signature

     

Tenant Name & Date