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To the Manitoulin-Sudbury District Services Board:
I am applying for emergency assistance under the Homlessness Prevention Program and in support of my application, I make the following statements:
I/We understand that emergency assistance will only be provided once all eligibility criteria have been met to the satisfaction of the DSB.
Additionally, I/we understand that this is short-term emergency service which I /we can access only once every 12 months.
Additionally, I/we hereby consent to the disclosure or exchange or transmittal of information as it relates to my/our request for emergency assistance. I/we also consent for the Manitoulin-Sudbury DSB to collect and keep on file information as it relates to my/our request for emergency assistance.
I/We are also willing to implement the attached action plan (if applicable).
I/We agree that signing this document warrants that I/we fully agree with the statements mentioned above and that all information given on this form, to the best of my/our knowledge is true and correct.