TEST: Outreach Referral

Progressive Housing Society is seeking your consent for the following purposes:

· Your consent to collect your personal information into the computer system we use. o This will help us meet your needs and connect you with appropriate support services. · Your consent to share your personal information with our funder, BC Housing. o BC Housing is responsible for hosting the computer system we use to help manage our services. o BC Housing will use the information in the system, at an aggregate level, to help improve services and funding. · Your consent to migrate your personal information from the current computer system we use to the new one we will be using in the future. o If you are an anonymous client in our current system, we will add your name and date of birth to your anonymous record, and it will be shared in the new system. · Your consent to share your personal information with other service providers using the system. o The new computer system we will be using in the future will allow for some data sharing. o If you require services from another service provider, authorized staff will be able to access your personal information to improve the consistency and quality of services provided to you. · If you are accompanied by your children who are under the age of 19, we will also need to collect personal information about them. This is to ensure that information about families using services is recorded accurately. · Your consent to share limited non-identifying information with Employment and Social Development Canada. o They will use this data to help create a national picture of the scope of homelessness in Canada.

If you choose not to sign this document, services will still be provided to you, except in regard to rent supplements. If your service provider has rent supplements, you will need to sign this consent form to be considered for and to receive a rent supplement (for accounting purposes).

I understand I can withdraw my consent at any time, except if I am receiving a rent supplement.

I have read and understand the information provided above, and I consent to the collection, use and disclosure of my personal information as described.

CONSENT TO COLLECTION, USE AND DISCLOSURE OF PERSONAL INFORMATION Progressive Housing Society (“we” or “us”) uses Greater Vancouver’s homelessness management information system (“HMIS”). What is the HMIS? The HMIS is a system owned by Lu’ma Native Housing Society (“Lu’ma”) and makes it easier for you to access housing and related support services by allowing multiple service providers in Greater Vancouver to access your information to assess your need for housing and deliver housing and related services and support to you. HMIS also allows Lu’ma and us to better understand the needs in the community, which helps us improve the delivery of our services. What is a Participating Organization? The HMIS is used by organizations who provide services to or support individuals who are homeless or at risk of homelessness in Greater Vancouver and who are contractually required to protect, collect, use and disclose your personal information only for purposes relating to adding it to and updating the HMIS, assessing your vulnerability to housing instability, helping you access housing and referring you to services and supports available to individuals and families who are homeless or at risk of homelessness (the “Participating Organizations”). Each and every organization having access to the HMIS, including Lu’ma, is required to comply with applicable privacy laws, including the Personal Information Protection Act (British Columbia). A current list of Participating Organizations, which includes us, can be provided upon request from Lu’ma or any Participating Organization. What information is being collected about me? We will collect from you the types of personal information as described on page 2, and as may be updated from time to time (your “Personal Information”). We [participant organization collecting information] and Lu’ma are accountable to you with respect to your Personal Information. Who will have access to my information? We will enter the Personal Information into the HMIS by using a computer and the Participating Organization and Lu’ma will have access to your Personal Information, as well as additional Participating Organizations but only on a need-to-know basis for the purposes of coordinating and delivering services to you. We have appropriate policies and procedures in place in this regard to protect your Personal Information. When will my information be disclosed? Your Personal Information may be disclosed to additional third parties to the extent required by applicable laws, including but not limited to a subpoena, court order or to report abuse or neglect of a child to the extent required under the Child, Family and Community Service Act (British Columbia). How will my information be used by Participating Organizations and Lu’ma? Participating Organizations may only access and use the Data to update the HMIS, to assess my vulnerability and the vulnerability of my children and dependents relating to housing instability, to help me access housing and to refer me to services and supports available to individuals and families who are homeless or at risk of homelessness. Lu’ma may also use my Personal Information to create aggregate anonymized data for purposes related to funding and to improve the delivery and scope of services available to individuals who are homeless or at risk of homelessness. Is my information safe? As with any disclosure of Personal Information to a third party, there may be risk of a security breach or that someone may obtain and use your information inappropriately. However, Lu’ma and us have taken steps to reduce that risk by implementing security measures, limiting who has access to HMIS and requiring each Participating Organization to safeguard your Personal Information. Who can I contact if I have questions, if I want to correct or update my information or want access to my information? Please contact Lu’ma at Kyle@LNHS.ca. By signing below, I understand and consent that my Personal Information as described on page 2 and as may be updated from time to time may be collected by the Participating Organization and entered into the HMIS and disclosed to Lu’ma, and Participant Organizations to update the HMIS, to assess my vulnerability to housing instability, and the vulnerability of my children and dependents, to help me access housing and to refer me to services and supports available to individuals and families who are homeless or at risk of homelessness. I also understand that the Personal Information will not be disclosed to parties who are not Participating Organizations except to the extent required by applicable laws. I understand that [Participating Organization Name], and Lu’ma collect, use and disclose the Personal Information in accordance with the HMIS privacy policy and [INSERT SPECIFIC PO’s] privacy policy. A copy is available by contacting Lu’ma or upon request from any Participating Organization.