Please read the following statements carefully and understand each provision. Counselors must have this form signed or verbally agreed to before reviewing your financial information and before advising you regarding your specific situation.
Non-Discrimination Policy: Our agency serves all members of the community. We do not engage in the practices of discrimination in the selection and participation of clients in our programs or services with respect to race, religion, color, gender, national origin or handicap.
Confidentiality: I understand that I will be provided with a confidential money management interview.
Grievance: I understand that in the event I am dissatisfied, I can utilize the Client Grievance Procedure.
Course of Action: I will be given a written assessment outlining a suggested plan of action that will be based on one of the following options:
a.) I will handle any financial concerns on my own or
b.) I may choose to enroll in the agency’s Debt Management Program in which the agency serves as a neutral third party negotiating with creditors to liquidate financial obligations.
Dual Role: Our DMP’s serve the dual role of helping you repay your debts and helping creditors to receive the money that you owe them.
Funding: Our agency receives funding in the form of donations and grants from individuals and entities that support financial counseling.
I understand that a portion of the agency funding comes from voluntary contributions from creditors who participate in Debt Management Programs (DMP). Since creditors have a financial interest in getting paid, most are willing to make a contribution to help fund our agency. These contributions are usually calculated as a percentage of payments you make through your DMP – up to fifteen percent (15%) of each payment received. However, your accounts with your creditors will always be credited with one hundred percent (100%) of the amount you pay through us and we will work with all your creditors regardless of whether they contribute to our agency.
Impact on Credit: Your credit report is not impacted by you obtaining counseling through our agency. Our agency will not disclose or provide any information about this counseling session to a credit reporting agency.
Your participation in a debt repayment program will not change anything which is already on your credit report. If your credit report reflects that you have paid as agreed in the past, a debt management program can have a negative impact on a credit worthiness decision by a potential creditor, landlord, or employer in the future. In addition, creditors may report that you are on a debt management program and are not paying as originally agreed although they have accepted the reduced payment plan.
It is important to note that if your credit report does not currently reflect a positive payment history, making consistent payments through the DMP may improve the credit worthiness review over time, as well as assist in paying down the overall indebtedness and improving credit scores.
Counselor qualifications: The consumer credit counselor conducting or supervising this session has been trained and certified in accordance with the NFCC standards.
Bankruptcy: You should also be aware that debts to creditors you repay through the plan may be able to be discharged through bankruptcy. Counselors cannot provide legal advice about bankruptcy.
Research: At sometime in the future, my information may be used for confidential research and/or a neutral third party may contact me to request an evaluation of the agency's services.
Liability: I hold the agency, its employees, agents and volunteers harmless from any claim, suit, action or demand of my creditors, myself or any other person resulting from advice or counseling. Nothing herein shall apply to actions or claims under the provisions of the United States Bankruptcy Code, 11 U.S.C. § 101 et seq.
