Statement of Counseling Services

I understand the agency will provide a confidential comprehensive personal money management interview. I understand that the interview will be conducted by a certified consumer credit counselor or qualified professional counselor.  All action plans, not conducted by a certified consumer credit counselor, will be reviewed by a certified consumer credit counselor.

I understand that by when I provide the agency with my mobile phone number, the agency may communicate with me via text message. Text message communication is not required to receive services from the agency. I understand that I may request Apprisen to discontinue sending text messages at any time. Message and data rates may apply.

I understand the Client Bill of Rights and Non-Discrimination Policy as defined on the back of this form.

I understand that in the event I am dissatisfied, I can utilize the Complaint Resolution Process as outlined on the back of this form.

I understand that most of the agency funding comes from voluntary contributions from creditors who participate in Debt Management Plans (DMP).  Since creditors have a financial interest in being paid, most are willing to make a contribution to help fund this agency.  These creditor contributions are usually calculated as a percentage of payments I make through my DMP – up to 15% of each payment received.  However, my accounts with my creditors are to be credited with one hundred percent (100%) of the amount I pay through the agency.  The agency will work with all my creditors regardless of whether they contribute to the agency.I understand that if I receive counseling relating to housing issues, information about my counseling session may be shared with funding sources for reporting and billing purposes.  Funding sources could include the Department of Housing and Urban Development (HUD), the National Foundation for Credit Counseling (NFCC), or any State Housing Grants.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.

I understand that I will be given a written assessment outlining a suggested client action plan which will be based on the following options:

• I will handle any financial concerns on my own.
• I may choose to enroll in the agency’s debt management plan.  The DMP is voluntary and serves the dual role of helping clients repay debts and helping creditors to receive the money owed to them.
• I may choose to discharge my debt through bankruptcy.  A counselor may answer questions about bankruptcy, but not give legal advice.  If I want legal advice, I will be referred for appropriate assistance.  While an attorney can make a recommendation to file bankruptcy, it is a personal choice based on individual circumstances.  I will inform the agency of the decision if I file bankruptcy.
• I will be referred to other services of the organization or another agency or agencies as appropriate that may be able to assist with particular problems that have been identified.

I understand that I am not obligated to receive, purchase, or use any other services (DMP, Housing, Bankruptcy) in order to receive counseling.  Other products/services offered by Apprisen may be available through other sources.

If I choose to participate in the DMP, the agency has no responsibility or obligation for any past, present, or future credit rating I receive.  In certain circumstances, a DMP may affect my credit rating negatively.  In the event that the counselor suggests a DMP, I will receive complete details of set-up and maintenance of the plan, including my responsibilities.

I understand that Apprisen may periodically share aggregated case file information for research and grant reporting requirements.  All data shared in this manner is anonymous and has all personal identifying information removed.

I hereby authorize Apprisen to release all non-public information it obtains about me to (1) my creditors and (2) third parties necessary to resolve the matter(s) discussed during my counseling session.  I further release and authorize all of my creditors to provide non-public information about me to Apprisen.

We pledge that our clients have the right:

• To prompt counseling services for managing money based on their financial situation;
• To be treated with dignity and respect;
• To be actively involved in a comprehensive assessment of their financial situation including an appropriate action plan;
• To express dissatisfaction through a Complaint Resolution Process;
• To discontinue their relationship with our agency at any time;
• To ask questions and have concerns addressed.

Our Service serves all members of this 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.

We are committed to providing you with high quality professional service.  However, if you are not satisfied with the services provided or if you want to make a complaint, we ask that you follow these guidelines:

• Step One: Try to resolve the issue with the staff member involved giving him or her specific information about your complaint.
• Step Two: If Step One is not possible or the issue is not resolved to your satisfaction call (800) 355-2227 and ask to be directed to the appropriate supervisor.  The supervisor may request a meeting with you (phone or face-to-face) or seek more information from a staff person.  The supervisor will respond within 3 business days to inform you that the issue is being researched.
• Step Three: If your issue is still unresolved you may appeal in writing directly to the President, at 690 Taylor Rd, Suite 150, Gahanna, OH 43230.  After additional fact finding, you will receive a concluding decision within 15 days.