By signing the Team Kentucky Fund Application, I also agree to each of the following statements on behalf of myself and all members of my Household:
I understand that information provided on or with my Team Kentucky Fund application ("Confidential Information") may be confidential or personal.
I authorize the Community Action Agency to share this Confidential Information among Community Action Kentucky, the Commonwealth of Kentucky, utility companies, mortgage companies, my landlord, grocery stores, and others (the "Data Recipients") as necessary for those entities to provide assistance to my Household and to administer and oversee the Team Kentucky Fund.
The sharing of Confidential Information is necessary in the performance of a legitimate government function.
- Each Data Recipient is held harmless and is released from claim, loss, demand, damage, and liability of any kind from each member of my Household in connection with sharing of Confidential Information.
- I authorize Data Recipients to provide notification of any breach or suspected breach involving Confidential Information by email at the provided email address. I will notify the Community Action Agency if my email address changes. I understand this is one possible method of notification and other method(s) of notification may be used.
- I am authorized to complete and submit this Team Kentucky Fund Application, including submitting certain Confidential Information and providing a release, on behalf of all the Household members