Program Design

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Transcripción

Program Design
Program Design
Supporting Documents
Task
Start
Date
End
Date
April
Status
Week 1
Planning and Partnerships
Meet with La Casa and CCCSSF to discuss program model and
goals
Meet with La Casa and CCCSSSF to solidify desired outcomes and
reporting
Finalize intake process with La Casa and CCSSF
Completed
Completed
Outreach and Recruitment
Develop Financial Counseling Referral Form
Review La Casa Intake Forms
Review La Casa Confidentiality Release Form
Develop Finanical Counseling Contact Form
Review CCCSSF Financial Counseling Intake Forms
Develop Outreach Fliers in English and Spanish
Tranlsate all documents in Spanish
Pull monthly/quarterly reports and review with stakeholders
Completed
Completed
Completed
Completed
Completed
Completed
Completed
Completed
Begin Client Outreach and Track Referrals
Counseling Cross Training
Train La Casa Staff on CCCSSF services and referral process
Develop Sensitivity Training for CCCSSF staff on Economic Abuse
and Domestic Violence
Record Sensitivity Training
Bi Monthly Check ins with Trainers
Data Tracking and Evaluation
Track client Referrals monthly
CCCSSF to provide SFOFE bi-monthly aggregated financial data
reports
La Casa to Provide bi-monthly aggregated demographic reports
Bi Monthly Check ins with Trainers
Document Trainer feedback on challenges and successes
Track changes in financial status for clients that have completed
2nd and 3rd counsleing sessions.
Develop White Paper and Toolkit
End data tracking and review aggregated results
Draft report summarizing program design, challenges, results and
best practices
Review and edit report with partners
Work with partners to develop toolkit informing other
stakeholders to assist other cities on replication
Finalize paper
Host Webinar to share learnings
Host recorded webinar and all materials on SMN website
Completed
20/30 clients
secured
Completed
Completed
Completed
Ongoing
Ongoing
Ongoing
Ongoing
Ongoing
Ongoing
Ongoing
Ongoing
Week 2
May
Week 3
Week 4
Week 1
Week 2
Week 3
Week 4
Domestic Violence Economic Intervention
San Francisco OFE
Project Budget
Project Partner
San Francisco OFE
San Francisco OFE
La Casa de las Madres
Credit Counseling Center of SF
Total Expenses
Activity
Program planning, leadership and management staff time
Development/dissemination of Financial Education materials, toolkit, webinars
Client outreach, marketing, follow up and retention
One-­‐on-­‐one financial counseling sessions, Financial Education workshops
Total Cost Services Given In Kind (CCCSF) Grant Funding Needed
$13,000
$13,000
$4,000
$4,000
$3,000
$3,000
$15,000
$10,000
$5,000
$35,000
$10,000
$25,000
La Casa De Las Madres Credit Counseling Pilot
Demographic Information
Age
Disability (yes/no/type)
Ethnicity
Family size/kids yes or no/pregnant yes or no
Primary language/limited english/fluency in english
Gender
Sexual Orientation
Type of housing
Zip code
Annual income
Employment status
Income source
Medical Insurance (yes or no)
Military Service (yes or no)
Financial
Primary Cause Of Financial Problem (Percentage Breakdown)
Gender (Percentage Breakdown)
Ethnicity (Percentage Breakdown)
Average FICO Score
Average Monthly Housing Expenses
Average Monthly Living Expenses
Average Total Unsecured Debt
Average Monthly Unsecured Debt Payment
Average Number of Unsecured Creditors
Average Total Assets
Average Total Liabilities
Average Total Savings
Sensitivity Training
Supporting Documents
HEARTS & FLOWERS
TENSION BUILDING
Apologies; promises; gifts;
idealized romance; victimblaming or abuse denial,
minimization; victimization
becomes complete as victim
wants to believe batterer and
feels guilty about incident;
bonding occurs; phase
disappears over time.
Minor incidents occur; victim
feels the need to calm and
placate abuser; “walking on
eggshells”; victim withdraws;
anticipation of battering causes
severe psychological stress;
minor incidents increase;
tension builds, and becomes
too much…
FEAR &
DENIAL
ACUTE BATTERING
La Casa de las Madres INCIDENT
● 415-503-0500 ● www.lacasa.org
Adult Crisis line ● 1-877-503-1850 ● 24 hours ● Toll free
Explosive release of tension;
Batterer seems completely out
of control; abuse becomes
worse over time; shortest
phase, 2-24 hrs.
The Cycle of Violence differs for each set of partners, each with their own unique
rhythm and participant behaviors. Yet three phases are typically represented: the tension
building phase, the explosion phase or acute battering incident, and the hearts and flowers
phase or kindness and contrite loving behavior. Over time, the kindness and apologies of
the hearts and flowers phase often disappear, and the relationship cycles continuously
between tension and explosion.
Because sometimes friends, relatives, and “helping people” become discouraged
when a victim remains in a threatening situation, it is vital to understand all of the
dynamics involved. Relationships do not generally begin as disruptive and abusive but
become so only after an initial platform of care has been established. Victims often stay
because some, however few, of their needs are being met. (See: “Why People Stay in
Abusive Relationships.”) The Cycle of Violence may combine with economic hardship,
social conditioning, emotional attachments, cultural traditions, religious beliefs and/or
other reasons to capture the victim in her own cycle of fear and denial making leaving or
escaping difficult.
(Adapted from Lenore Walker’s Battered Women: Harper & Row Publishers New York SF 1979)
La Casa de las Madres  415-503-0500  www.lacasa.org
Adult Crisis line  1-877-503-1850  24 hours Toll free
Cycle of Violence
Interpersonal violence generally follows a pattern of abuse. Battered women are not constantly
being abused nor does the violence occur at completely random times. Abuse tends to be
inflicted in a repeating cycle that is made up of three phases.
Phase One
•
•
•
•
•
•
•
•
•
•
•
Minor incidents occur
Woman tries to calm partner, using whatever she thinks will work
She feels there isn't much she can do
Batterer only acts out in private
Batterer becomes fearful she'll leave because he/she knows the behavior is not appropriate
Batterer becomes more jealous and possessive
Both people try to rationalize behaviors
She withdraws more and more
Minor incidents increase
Anticipation of battering/hurt causes severe psychological stress for women: can't sleep, loses appetite or
over eats, constant fatigue, headaches etc.
Tension becomes unbearable
Phase Two
•
•
•
•
•
•
•
•
•
Acute Battering Incident
Release of tension that has built up in phase one
Batterer loses control over his/her behavior
Battering begins to teach her a lesson-not to hurt her
Batterer doesn't remember much during the incident: women do
Woman may try to wait out the storm rather than fighting back, thinking she'd be more hurt if she did
Woman may consciously or unconsciously believe she provoked the incident, she can no longer tolerate
her terror, anger, or anxiety
Attack is usually followed by shock, denial, disbelief
Women do not seek help during phase two unless badly hurt and tend to return to partners from
emergency rooms
Briefer phase than others: 2-24 hours
Phase Three
•
•
•
•
•
•
•
•
•
•
•
•
•
Tension Building Phase
Kindness and Contrite Loving Behavior
Welcomed by both
Batterer knows he/she went to far and tries to make up
Period of unusual calm
Batterer is sorry, begs forgiveness, and promises never to do it again
Batterer is sincere and believes he/she can control self
Woman wants to believe batterer
She sees (again) how wonderful he/she can be
Traditional notion that "love conquers all" prevails
Woman feels responsible for batterer and her own victimization
Batterer reminds her of how much she is needed
Each person is dependent on the other, bonding occurs
Hard to break the bond in phase three, both want to make their relationship work
Victimization of woman becomes complete
(Adapted from Lenore Walker: Battered Women: Harper & Row Publishers New York SF 1979)
La Casa de las Madres  415-503-0500  www.lacasa.org
Adult Crisis line  1-877-503-1850  24 hours Toll free
POWER AND CONTROL
WHEEL
.
INTIMIDATION
& THREATS
ISOLATION &
EXTREME JEALOUSY
▪Making/carrying out threats to do
▪Controlling who he/she is friends with,
something to hurt her/him
where he/she goes, what he/she does
▪Threatening to leave her/him
▪Not
letting her/him work or be involved
▪Threatening to commit suicide
in her/his own activities
▪Threatening to report her/him to
▪Keeping constant tabs on her/
immigration, CPS, or other system
him, including through a pager
▪Making her/him drop charges
PHYSICAL
EMOTIONAL &
▪Making her/him do illegal things or cell phone
ABUSE
▪Making her/him afraid with ▪Accusing her/him of
PSYCHOLOGICAL
looks, actions, or gestures cheating without good
▪Hitting, pushing, grabbing,
ABUSE
reason
▪Smashing things or
scratching, shaking, biting,
destroying her/his ▪Not allowing her/
▪Criticism, name calling, put-downs
pinching, strangulation, o any other
him any privacy
property
▪Insulting partner’s race or heritage
contact intended to cause intimidation
▪Abusing pets/
▪Making her/him feel bad about themselves,
or harm
loved ones
attacking her/his self-esteem, humiliating her/him
▪Using larger body size/strength against her/him
▪ Destroying her/his spirit, making her/him feel guilty
▪Denying her/his physical needs, i.e. eating or
▪The “silent treatment”
sleeping
▪Making partner think she/he is crazy, playing mind games
▪Forced use of substances, i.e. alcohol or drugs
ECONOMIC ABUSE
POWER
&
CONTROL
MINIMIZING, DENYING, & BLAMING
▪Preventing her/him from getting or keeping a job
▪Making light of the abuse and not taking
▪Forcing her/him to work in a role against her/his will
her/his concerns about it seriously
▪Making her/him ask for money
▪Denying that the abuse ever happened
▪Giving her/him an allowance
▪Shifting the responsibility for the
▪Taking her/his money
abusive behavior
SEXUAL
▪Not letting her/him know about or
USING
▪Saying he/she caused
ABUSE
have access to family income
the abuse
PRIVILEGE
USING
▪Expecting her/him to pay
▪Forcing /manipulating
CHILDREN
▪Treating her/him like
for everything
her/him into sex with
a servant
▪Making her/him
partner or someone else
▪Making all the big
feelactos
guilty about
▪Forcing her/him to view
*La forza a cometer
decisions
the children
pornography or sexual activity
▪Being the one to define roles
▪Using children to relay
▪Unwanted touch or harassing
ilegales words
▪Acting like to head of the
messages
▪Unwanted pregnancy, miscarriage, ‘
household
▪Giving
the
children
abortion; birth control sabotage
▪Asserting superiority through
negative messages about
▪Forced sex while drunk, high,
gender/class/social status/
her/him
or sleeping
cultural heritage, etc.
▪Using visitation to harass
▪Guilt-tripping about sex
▪Threatening to take away the
▪Treating her/him like
children
a sex object
▪Hurting or threatening to hurt the
▪Insulting her/his
sexuality
children
Adapted from materials created by:
▪Using children as a way to create
Domestic Abuse Intervention Project,
dependency
Duluth , Minnesota
La Casa de las Madres 415-503-0500 www.lacasa.org
Adult Crisis Line 1-877-503-1850 24 hours Toll free
Why People Stay In Abusive Relationships
It is important to understand that there are many reasons why people
stay in unhealthy relationships. Some of them are listed below:
Economic Dependency: Who will support her/him and/or the children?
Parenting:
Wanting 2 parents for the family.
Religious:
Pressure to keep the family union.
Family:
Extended family pressure to keep family together.
Fear:
Fear of being alone, of being on her/his own and
that he/she can’t cope with home & children by
herself.
Loyalty:
If partner got sick he/she would stay.
Pity:
Feeling sorry for her/his partner.
Rescue Complex:
If he/she stays, he/she can “save,” fix, or change
his/her partner.
Fear of Suicide:
Partner threatens suicide if he/she leaves.
Denial:
It’s not really so bad. Partner acts like abuse is
nothing.
Love:
Her/his partner can be loving. He/She loves
his/her partner despite the abuse.
Responsibility:
It is her/his duty to make the relationship work.
Duty:
Responsibility to the relationship or marriage or
belief that people must put up with abusive
behavior.
Guilt:
Feels responsible for problems in the relationship
and the abusive partner reinforces this feeling.
Shame, embarrassment,
and humiliation:
He/She doesn’t want anyone to know.
Security:
Wanting to live happily ever after.
Identity:
He/She feels a partner will make themselves
complete.
Low self-esteem:
It must be her/his fault; he/she deserves it; he/she
will never find anyone better.
Sex role conditioning: The belief that one partner is dominant over the
other, men can’t help being violent, or women are
responsible for the success of relationships.
Hope:
Memories of happy times, promises to change, or
belief that her/his behavior will make the abuse stop.
La Casa de las Madres 415-503-0500 www.lacasadelasmadres.org
Adult Crisis line 1-877-503-1850 24 hours Toll free
Adapted from Lenore Walker’s Battered Women:
Harper & Row Publishers New York SF 1979
Lindsay Sweetnam
[email protected]
Business Line: 415-503-0500
24 Hour Crisis Line:
1-877-503-1850
Who is affected by Domestic
Violence?
• Nearly one in four women in the United States reports
experiencing violence by a current or former spouse or
boyfriend at some point in her life.1
• In San Francisco, the police department responds to about
4,200 domestic violence reports annually.
• Domestic Violence affects people of all races, nationalities,
socio-economic statuses, educational levels,
sexual orientations, gender identities, and
immigration statuses.
1
Adverse Health Conditions and Health Risk Behaviors Associated with Intimate Partner Violence, Morbidity and Mortality Weekly Report. February 2008. Centers for Disease Control and
Prevention. Available athttp://www.cdc.gov/mmwr/PDF/wk/mm5705.pdf
What is domestic violence?
Power
Control
POWER AND CONTROL WHEEL
POWER AND CONTROL WHEEL
POWER AND CONTROL WHEEL
POWER AND CONTROL WHEEL
POWER AND CONTROL WHEEL
POWER AND CONTROL WHEEL
POWER AND CONTROL WHEEL
POWER AND CONTROL WHEEL
POWER AND CONTROL WHEEL
POWER AND CONTROL WHEEL
Adapted from Lenore Walker’s Battered
Women: Harper & Row Publishers New York SF
1979
Why People Stay?
• Economic
Dependency
• Love
• Hope
• Fear
• Guilt/Shame
• Religious beliefs
• Family
• Loyalty/Duty
•
•
•
•
Rescue Complex
Fear of Suicide
Denial
Values about
parenting/family
• Low Self-esteem
• Sex Role Conditioning
• Lack of role models
Lindsay Sweetnam
[email protected]
Business Line: 415-503-0500
24 Hour Crisis Line:
1-877-503-1850
DV101: What is economic abuse
and how does it affect our clients?
Business Line: 415-503-0500
24 Hour Crisis Line:
1-877-503-1850
Take a moment to write a secret about yourself
on a piece of paper,
Take a moment to write a secret about yourself
on a piece of paper,
something you don’t share with most people,
Take a moment to write a secret about yourself
on a piece of paper,
something you don’t share with most people,
or maybe something you’ve never shared with
anyone.
Take a moment to write a secret about yourself
on a piece of paper,
something you don’t share with most people,
or maybe something you’ve never shared with
anyone.
I can’t tell you what’s going to happen to that
secret right now,
Take a moment to write a secret about yourself
on a piece of paper,
something you don’t share with most people,
or maybe something you’ve never shared with
anyone.
I can’t tell you what’s going to happen to that
secret right now,
but I can tell you that I will do my best to keep
it safe.



Approximately 1 in 3 women worldwide reports
experiencing physical or sexual violence by a current or
former partner at some point in her life.1
Nearly one in four women in the United States reports
experiencing violence by a current or former spouse or
boyfriend at some point in her life.²
Domestic Violence affects people of all races,
nationalities, socio-economic statuses,
educational levels, sexual orientations,
gender identities, and immigration statuses.
WHO Multi-county Study on Women’s Health and Domestic Violence Against Women: Summary Report of Intitial Results on Prevalence, Health Outcomes and Women’s Responses. Geneva,
World Health Organization, 2005.
² Adverse Health Conditions and Health Risk Behaviors Associated with Intimate Partner Violence, Morbidity and Mortality Weekly Report. February 2008. Centers for Disease Control and
Prevention. Available athttp://www.cdc.gov/mmwr/PDF/wk/mm5705.pdf
1
Power
Control
POWER AND CONTROL WHEEL
Adapted from Lenore Walker’s Battered
Women: Harper & Row Publishers New York SF
1979

Lack of experience managing money

Barriers to Employment


Barriers to Housing/Increased risk of
homelessness
Managing finances during separation

Partner had always controlled incoming and
outgoing money

No experience budgeting or paying bills

No access to accounts (bank, credit, or bills)

Kept unaware of income

Little to no work history or inconsistent work
history

Need for flexible schedule

Losing job due to abuse

Partner threatens to out LGBTQ victim

Childcare needs

Poor or no credit history

Poor rental history

No landlord references

Criminal History

Discrimination by landlords

Lack of affordable housing


According to the U.S. Department of Housing
and Urban Development, domestic violence is
the third leading cause of homelessness
among families.
Nationally, approximately half of all women
and children experiencing homelessness are
fleeing domestic violence (Zorza, 1991;
National Coalition Against Domestic Violence,
2001)

Taking on debts the abusive partner
accumulated (in either partner’s name)

Fear of asking for child support

Batterer refuses to pay child/spousal support

Partner hides assets

Having to give up one’s own assets
Think of a time when you stayed in
something…anything…for longer than you
should have.
Think of a time when you stayed in
something…anything…for longer than you
should have.
For whatever reason, you knew this thing
wasn’t right for you anymore,
Think of a time when you stayed in
something…anything…for longer than you
should have.
For whatever reason, you knew this thing
wasn’t right for you anymore,
but you didn’t leave right away.
Think of a time when you stayed in
something…anything…for longer than you
should have.
For whatever reason, you knew this thing
wasn’t right for you anymore,
but you didn’t leave right away.
Maybe it was a relationship, a job, a program in
school.
Think of a time when you stayed in
something…anything…for longer than you
should have.
For whatever reason, you knew this thing
wasn’t right for you anymore,
but you didn’t leave right away.
Maybe it was a relationship, a job, a program in
school.
Think of all the factors that contributed to you
staying.
Think of a time when you stayed in
something…anything…for longer than you
should have.
For whatever reason, you knew this thing
wasn’t right for you anymore,
but you didn’t leave right away.
Maybe it was a relationship, a job, a program in
school.
Think of all the factors that contributed to you
staying.
Write them down.
Why People Stay?
•
•
•
•
•
•
•
•
Love
Hope
Fear
Guilt/Shame
Religious beliefs
Family
Loyalty/Duty
Low Self-esteem
•
•
•
•
Rescue Complex
Fear of Suicide
Denial
Values about
parenting/family
• Sex Role Conditioning
• Lack of role models
• Economic
Dependency
Lindsay Sweetnam
[email protected]
Business Line: 415-503-0500
24 Hour Crisis Line:
1-877-503-1850
CCCSSF Intake Forms
Supporting Documents
Consumer Credit Counseling Service of San Francisco
595 Market Street • 15th Floor • San Francisco, CA 94105
800.777.7526 • 415.788.0288 • 415.777.4030 fax • www.cccssf.org
Client Information
COMPLETE NAME (first / middle initial / last / jr / sr)
SPOUSE’S NAME
SOCIAL SECURITY NUMBER
SPOUSE’S SOCIAL SECURITY NUMBER
DATE OF BIRTH
SPOUSE’S DATE OF BIRTH
CURRENT ADDRESS
HOME PHONE
HOME STATUS
q Renting
NUMBER OF DEPENDENTS
q Buying
q Other
MARITAL STATUS
SPOUSE’S EMPLOYER
WORK PHONE (optional)
SPOUSE’S WORK PHONE (optional)
EMAIL
SPOUSE’S EMAIL
Areas of Interest
CCCS Counselors can answer questions on a variety of subjects. Please check as many as apply:
q Budgeting
q Student Loans
q Back Taxes
q Fair Debt Collection
q Credit Reports
q Getting Out of Debt
q First-Time Home Purchase
q Establishing Credit
q Credit Problems
q Saving Money
q Credit Effects of Bankruptcy
q Mortgage Issues
How Can We Help You?
In order to help us give you the best service possible, please list your most pressing concerns and/or problems:
About Our Organization Consumer Credit Counseling Service of San Francisco is a non-profit community service. As
a member of the National Foundation for Credit Counseling, we adhere to quality standards that include accreditation,
certification of counselors, audits and core policies to ensure quality service. We receive our funding from various
sources, including grants and fees for specialized education projects. Most of our funding comes from voluntary
contributions from creditors who participate in Debt Management Plans (DMP). DMPs are voluntary programs that
serve the dual role of helping you repay your debts and helping creditors to receive the money owed to them.
Since creditors have a financial interest in getting paid, most are willing to make a contribution to help fund
our agency. The 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
be credited with one hundred percent (100%) of the amount you pay through us.
COPYRIGHT © 2011 CCCSSF • REV0311
q Single q Married q Divorced q Separated q Widowed
EMPLOYER
Income
Calculate your monthly income. If you know what your gross pay (before taxes and other deductions) is, please enter that.
However, net pay (face value of your check) is the more important figure. Include variable income received each month,
such as commissions, as well as periodic income, such as a large tax refund or bonus. This will have to be divided by 12 to
get the monthly figure.
Monthly Income
Gross
Net
Income Source/Employer
Income Source/Employer
Retirement/Pension
Child Support/Alimony
Social Security
Food Stamps
Unemployment Insurance
Support from family/friends
Other
Total
Property
Present Value
Amount Owed
Payment
Present Value
Amount Owed
Payment
Present Value
Monthly Contribution
Home Mortgage
Second Mortgage
Vehicle Payment #1
Vehicle Payment #2
Total
Assets & Liabiities
Boat
Property/Land
Timeshare
401K/403B Loan
Other
Total
Investments
401K-403B Contribution
Savings Account
IRA
Stocks/Mutual Funds
Cash Value Life Insurance
Other
Total
COPYRIGHT © 2011 CCCSSF • REV0311
Other
Expenses
Enter your monthly expenses below. Since many expenses are variable, such as utilities and groceries, it is important to
average these expenses. Other expenses are periodic (such as insurance or vehicle registration). Calculate the annual
amount of these expenses then divide by 12. (*Make sure to exclude payroll deducted amounts such as insurance, child
care, or transportation benefits.)
Current
Proposed
Miscellaneous
Rent/Mortgage
Tuition/Lessons
2nd Mortgage/Equity Line
Student Loans
Condo Fees/HOA Dues
State Owed Taxes
Property taxes
Life Insurance*
Homeowner’s/Renter’s
Insurance
Union Dues
Movies/Video
Water/Sewer/Garbage
Dining Out
Cable/Satellite
Sports/Hobbies/Clubs
Telephone
Monitored Alarm
Current
Proposed
Groceries/Household Items
Gifts for Holidays/Birthdays
Pet Care
At Work/School
Cell Phone/Pager
Current
Proposed
Banking Fees/Postage
Health/Dental Insurance*
Cigarettes/Alcohol
Prescriptions/Doctor’s Visits
Internet Service
Current
Proposed
Vehicle Payment #1
Church/Charity Contributions
401(k)/403(b) Loans
401(k)/403(b) Contributions
Vehicle Payment #2
Boats/Water Vehicles
Vehicle Payment #3
Federal Taxes Owed
Gasoline/Oil/Repairs
IRA’s
Auto Insurance
Stocks/Mutual Funds
DMV Registration
Other
Tolls/Parking/Bus*
Child Care
Proposed
Beauty/Barber
Property/Land
Transportation
Current
Savings
Gas/Electric
Medical
Proposed
Storage Fee
Timeshares
Food
Current
COPYRIGHT © 2011 CCCSSF • REV0311
Housing
Other
Current
Proposed
Daycare/Sitting*
Totals
Child Support/Alimony
Total Monthly Expenses
Unsecured Debt
Please list all unsecured debts with balances over $100 (except auto loans and mortgages) along with the name of the
creditor, interest rate, total balance owing and the required minimum payment. This includes credit and charge cards,
installment loans, personal loans and outstanding medical bills. Do not include mortgage, vehicle or student loans. Please
have your current creditor statements available during your counseling session.
Name of
Creditor
Account
Number
Interest
Rate
Monthly
Payment
Current
Balance
Months
Late
1
2
3
4
5
6
COPYRIGHT © 2011 CCCSSF • REV0311
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8
9
10
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12
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15
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For Counselor Use Only
Client Number
Results
Proposed Deposit
Date Counseled
Counselor
Notes
Consumer Credit Counseling Service of San Francisco
595 Market Street • 15th Floor • San Francisco, CA 94105
800.777.7526 • 415.788.0288 • 415.777.4030 fax • www.cccssf.org
Agreement for Counseling Services
Please read the following statements carefully. Initial the line next to each statement to indicate understanding.
(The singular is used even when the plural may apply.)
_____ I understand that some of CCCS funding comes from voluntary contributions from creditors who
participate in the Debt Management Plan (DMP). Since creditors have a financial interest in getting
paid, most are willing to make a contribution to help fund CCCS. These contributions are usually
calculated as a percentage of the payments I make through my DMP-up to fifteen percent (15%) of each
payment received. However, my accounts with my creditors will always be credited with one hundred
percent (100%) of the amount I pay. The absence of a creditor contribution will not affect CCCS’
willingness to work with that creditor.
_____ I understand that if I opt to begin a DMP, my participation may affect my credit report and credit score,
depending on my creditors’ policies with respect to the DMP and my payment record prior to and during
my participation in a DMP. A DMP could 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 I am on a
DMP and not paying as originally agreed although they have accepted a reduced payment. The agency
has no responsibility or obligation for any past, present, or future credit rating I receive. The DMP will
include my unsecure debt and may include certain secured debts.
_____ I understand that while a DMP may be an option available to me for debt repayment, it is not a suitable
option for all clients. I understand my counselor will discuss all of my options to resolve my situation.
I understand that receipt of financial counseling services does not automatically guarantee that I will
participate in DMP services.
_____ I understand that, where permitted by state law, the establishment of a DMP will result in a DMP
Education fee, requested prior to the implementation of the DMP, and a monthly administrative fee
thereafter. I understand services provided are not contingent on payment of these fees.
_____ A counselor may answer questions and provide information 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 may be referred to other services of the organization or another agency or agencies as appropriate that
may be able to assist with particular concerns that have been identified. I understand I am not obligated
to use any of the services offered to me.
COPYRIGHT © 2011 CCCSSF • REV0311
_____ I understand the agency will provide a confidential personal money management, housing, and/or credit
report consultation after which I will receive a written action plan consisting of recommendations for
handling my finances, possibly including referrals to other services and agencies as appropriate.
_____ At some time 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.
_____ I understand that in the event I am dissatisfied, I can utilize the Complaint Resolution Process, a copy of
which is available upon request.
_____ I understand that unless I choose to “opt-out”, the agency will, if asked by my creditors, verify my
appointment, as well as the date and results of that appointment. I further understand that I have the
right to “opt-out” of having this information shared by calling the CCCS “opt-out” line (888-440-4663)
as stated in the CCCS Privacy Policy.
_____ I authorize the agency to access my credit report for account verification and for confidential research
in the future. I understand these reports being accessed will not have a detrimental affect on my credit
score.
CALIFORNIA RESIDENTS:
_____ Complaints related to this agreement may be directed to the California Department of Corporations.
This non-profit community service organization has adopted best practices for debt management plans
and debt settlement plans, and a copy will be provided upon request.
Client__________________________________________________________ Date______________________
Client__________________________________________________________ Date______________________
Counselor______________________________________________________ Date______________________
Consumer Credit Counseling Service of San Francisco provides the following free services to consumers
nationwide:
• Money management counseling
• Housing counseling
• Workshops
• Referral sources
• Library of education materials
Consumer Credit Counseling Service of San Francisco provides the following services for a small fee:
• Debt Management Plans: $45 one-time education fee; $35 maximum monthly fee, where allowed by
state law
Hours: 8:00 am – 8:00 pm Monday to Thursday; 8:00 am – 5:00 pm Friday and Saturday
COPYRIGHT © 2011 CCCSSF • REV0311
ILLINOIS RESIDENTS:
_____ The Debt Management Services Act is administered by the Illinois Department of Financial Institutions.
Rev. 12/2010
FACTS
WHAT DOES CCCS OF SAN FRANCISCO
DO WITH YOUR PERSONAL INFORMATION?
Why?
Financial companies choose how they share your personal information. Federal law gives
consumers the right to limit some but not all sharing. Federal law also requires us to tell you
how we collect, share, and protect your personal information. Please read this notice carefully to
understand what we do.
What?
The types of personal information we collect and share depend on the product or service you
have with us. This information can include:
• Social Security number, name, address, assets, income, and expenses
• Credit information and credit history information from credit reporting agencies
• Account balances, payment history, transactions and usage
How?
All financial companies need to share non-public personal information to run their everyday
business. In the section below, we list the reasons financial companies can share their
non-public personal information; the reasons CCCS of San Francisco chooses to share; and
whether you can limit this sharing.
Reasons we can share your personal information
Does share
Can you limit this sharing?
For our everyday business purposes—
such as to process your transactions, maintain your
account(s), respond to court orders and legal
investigations, or report to credit bureaus
Yes
Yes
For our marketing purposes—
to offer our products and services to you
No
N/A
For joint marketing with other financial companies
No
N/A
For our affiliates’ everyday business purposes—
information about your transactions and experiences
Yes
No
For our affiliates’ everyday business purposes—
information about your creditworthiness
No
N/A
For nonaffiliates to market to you
No
N/A
• Call 1-888-440-4663 – our menu will prompt you through your choice(s)
To limit
our sharing
Please note:
If you are a new customer, we can begin sharing your information 5 days from the date we sent
this notice. When you are no longer our customer, we continue to share your information as
described in this notice.
However, you can contact us at any time to limit our sharing.
Questions?
Call 1-800-777-7526 or go to www.cccssf.org
Page 2
Who We Are
Who is providing this notice?
Consumer Credit Counseling Service of San Francisco
What We Do
How does CCCS of San Francisco
protect my personal information?
To protect your personal information from unauthorized access
and use, we use security measures that comply with federal law.
These measures include computer safeguards and secured files
and buildings.
How does CCCS of San Francisco
collect my personal information?
We collect your personal information, for example, when you
• Provide it orally, in writing via hard copy or web forms
• Provide permission for us to access your credit report
• Authorize a third party to provide it
Federal law gives you the right to limit only
Why can’t I limit all sharing?
• sharing for affiliates’ everyday business purposes—information
about your creditworthiness
• affiliates from using your information to market to you
• sharing for nonaffiliates to market to you
State laws and individual companies may give you additional rights to
limit sharing.
What happens when I limit sharing
for an account I hold jointly with
someone else?
The information shared on that account will be limited
Definitions
Affiliates
Companies related by common ownership or control. They can be
financial and nonfinancial companies.
Nonaffiliates
Companies not related by common ownership or control. They can be
financial and nonfinancial companies.
Joint marketing
A formal agreement between nonaffiliated financial companies that
together market financial products or services to you.
Other Important Information
We will not be able to assist you with a Debt Management Plan if you do not provide us your consent to share
information with your creditors. We may also disclose any non-public personal information about you or former
customers to anyone as permitted by law (for instance, if we are compelled by legal process) even if you have
opted out.
PRIVACY POLICY IN PRACTICE
We are committed to the privacy of our clients. We realize that the concerns you bring to us are highly personal in
nature and assure you that all information you share with us will be managed within legal and ethical considerations.
Your nonpublic personal information, such as your debt, income, living expenses and other information concerning
your financial circumstances, will be provided to creditors and others only with your authorization.
Opting-out
You may opt-out of disclosures of your nonpublic personal information during your counseling session, or by calling
888-440-4663. If you choose to opt-out, we will not be able to answer questions from your creditors. If at any time,
you change your mind and wish to opt-in to disclosure, you may call us at 888-440-4663.
Release of information to third parties
If you have not opted-out, we may disclose some or all of the information that we collect to your creditors or third
parties where we have determined that it would be helpful to you or would aid us in counseling you.
Generally we will provide only the following information to your creditors if asked:
• Verification of appointment with us
• Date of counseling
• Outcome of counseling session
We may also disclose any nonpublic personal information about you to anyone as permitted by law (for instance, if
we are compelled by legal process).
We may compile data and aggregate information that you give to us, but this information may not be disclosed in a
manner that would personally identify you in any way.
We restrict access to nonpublic personal information about you to those employees who need to know that
information to provide services to you. We maintain physical, electronic and procedural safeguards that comply
with federal regulations to guard your nonpublic personal information.
The Debt Management Plan
If you choose to begin a Debt Management Plan, we will obtain your express consent to disclose to creditors
nonpublic personal information about you. We will not be able to assist you with a Debt Management Plan if you do
not provide us your consent to share information with your creditors.
CCCSSF • 595 MARKET STREET, 15TH FLOOR, SAN FRANCISCO, CA 94105 • WWW.CCCSSF.ORG • 800-777-7526
Consumer Credit Counseling Service of San Francisco
595 Market Street • 15th Floor • San Francisco, CA 94105
800.777.7526 • 415.788.0288 • 415.777.4030 fax • www.cccssf.org
Información personal
NOMBRE COMPLETO
NOMBRE COMPLETO DE SU ESPOSO/A*
NÚMERO DE SEGURO SOCIAL
NÚMERO DE SEGURO SOCIAL DE SU ESPOSO/A*
FECHA DE NACIMIENTO
FECHA DE NACIMIENTO DE SU ESPOSO/A*
DOMICILIO (calle, cuidad, estado, código postal)
NÚMERO DE TELÉFONO
USTED ESTÁ:
q Alquilando
NÚMERO DE DEPENDIENTES
q Comprando
q Otro
ESTADO CIVIL:
q Soltero/a q Casado/a q Divorciado/a q Separado/a q Viudo/a
EMPLEADOR
EMPLEADOR DE SU ESPOSO/A*
TELÉFONO LABORAL (opcional)
TELÉFONO LABORAL DE SU ESPOSO/A* (opcional)
CORREO ELECTRÓNICO
CORREO ELECTRÓNICO DE SU ESPOSO/A*
Areas de interes
Los asesores de CCCS pueden responder sus preguntas sobre diversostemas. Por favor indique sus áreas de interés.
q Efectos Crediticios de las
Quiebras
q Presupuestos
q Informes Crediticios
q Saldo de Deudas
q Adquisición de la Primera
Vivienda Propia
q Ahorro de Dinero
q Créditos
q Problemas Crediticios
q Cobro Equitativo de las
Deudas
q Impuestos Vencidos
q Temas Hipotecario
q Préstamos Estudiantiles
Como podemos ayudarle?
Para ayudar a CCCS a brindarle el mejor servicio posible, por favor detalle sus inquietudes y/o problemas más apremiantes.
Sobre Nuestra Organización
Consumer Credit Counseling Service of San Francisco es unservicio para la comunidad sin fines de lucro. Como miembros dela Fundación
Nacional para el Asesoramiento Crediticio, cumplimos con normas de calidad que incluyen la acreditación, certificación de asesores, auditorias
así como políticas básicas para asegurar un servicio de calidad. Recibimos nuestros fondos de diversas fuentes, incluyendo subsidios y becas
para proyectos educativos especializados. La mayor parte de nuestros recursos provienen de contribuciones llevadas a cabo por los acreedores
que participan en los Planes de Gestión de Deuda (DMP). Los planes DMP son programas voluntarios que cumplen con el doble propósito de
ayudarle a pagar sus deudas y de ayudar a sus acreedores a recibir el dinero que se les adeuda. Debido a que los acreedores poseen intereses
financieros con relación al cobro de sus deudas, la mayoría realiza contribuciones para ayudar a financiar nuestro organismo. Las contribuciones
se calculan en general a partir de un porcentaje de los pagos que usted realiza a través de su DMP, equivalente a hasta un quince por
ciento (15%) de cada pago recibido. Sin embargo, las cuentas que usted tiene con sus acreedores serán acreditadas con un monto
equivalente en un cien por cien (100%) del monto que usted paga a través de nosotros.
Ingresos
Calcule sus ingresos mensuales, si usted sabe cual es su remuneración bruta (sin descontar impuestos y otras deducciones), por favor
ingrese dicho monto. Sin embargo, la remuneración bruta (el valor nominal de su cheque) es la cifra más importante. Incluya los
ingresos variables recibidos cada mes, como ser las comisiones, y también los ingresos periódicos, como ser restitución de impuestos
o bonificaciones. Estos deberán dividirse por 12 para obtener la cifra mensual.
INGRESO MENSUAL
Bruto
Neto
Origen de los Ingresos / Empleado
Para el caso de
los ingresos, el
dinero en mano
o “ingreso neto”
tiene suma
importancia en
esta sección.
Origen de los Ingresos / Empleado
Jubilación / Pensión
Manutención de los hijos
Seguro Social
Tickets de Comida
Otros Ingresos
Otros Ingresos
Ingreso Total Mensual
BIENES
Valor Actual
Monto Adeudado
Pago
Valor Actual
Monto Adeudado
Pago
Valor Actual
Contribución mensual
Hipoteca
Segunda Hipoteca
Pago de Automóvil N° 1
Pago de Automóvil N° 2
ACTIVOS / PASIVOS
Embarcación
Propiedad / Terreno
Tiempo Compartido
Préstamo 401K-403B
Otro
Otro
INVERSIONES
401K-403B Contribution
Caja de Ahorros
Cuenta de Jubilación Individual
Acciones / Fondos de Pensiones
Otro
Otro
No olvide
incluir los
aportes 401(k)
o 403(b)
deducidos
de su salario.
Gastos
Los gastos de la casa se dividen en esenciales y variables. Para todas las categorías ingrese el monto mensual que usted gasta.
Muchos de los gastos fluctúan cada mes, por lo que deberá colocar un promedio. Otros gastos pueden ser periódicos (como ser
seguros, patentes de automotores e impuestos). Calcule el monto anual y divídalo por 12.
GASTOS VARIABLES:
GASTOS ESENCIALES:
VIVIENDA
Actual Mensual
PERSONAL
Alquiler / Hipoteca
Belleza / Peluquería
2da Hipoteca
Otro
Asociación de Propietarios de Viviendas
(Cuotas de Asociaciones)
ENTRETENIMIENTO
Cenas
Seguro del Propietario
Seguro del Inquilino
Deportes / Pasatiempos / Clubes /
Gimnasio
Gas / Electricidad (promedio)
Vacaciones / Viajes
Agua / Alcantarillado Público /
Recolección de Residuos
Material de Lectura / Música
Otro
Televisión por Cable o Satelital
VESTIMENTA
Teléfono
Actual Mensual
Comestibles / Artículos Domésticos
Actual Mensual
Seguro médico (odontológico/oftalmológico)
Lavadero / Tintorería
Mantenimiento / Limpieza
Servicio de la Piscina / Jardinería
MISCELÁNEOS
Actual Mensual
Cuidado de Animales Domésticos
Pago de Automóvil N° 2
Beeper / Teléfono Celular
Combustible
Gastos Bancarios / Correo
Mantenimiento / Reparaciones
Cigarrillos / Alcohol
Seguro del Automóvil
Computadora / Gastos Servicio de
Internet
Registro del Automotor
Religión / Caridad
Peajes / Estacionamiento / Transporte
público
Otro
Actual Mensual
Otro
Guardería Infantil / Cuidado de niños
Otro
Pensión Alimenticia / Manutención de
los Hijos
Otro
EDUCACIÓN
Actual Mensual
Regalos
Pago de Automóvil N° 1
CUIDADO DE MENORES
Actual Mensual
Alarma monitoreada
Recetas / Consultas Médicas
TRANSPORTE
Actual Mensual
Compras
ATENCIÓN DE LA CASA
En el Trabajo / En la Escuela
MÉDICOS
Actual Mensual
Cine / Video
Impuestos Inmobiliarios
ALIMENTOS
Actual Mensual
Actual Mensual
Otro
Clases particulares
Préstamos Estudiantiles
MISCELÁNEOS
Impuestos (pago mensual)
Seguro de Vida
Cuotas Sindicales
Gastos de Almacenamiento
Actual Mensual
Para el caso de los gastos anuales,
divida la cifra total por 12
y así obtendrá el pago mensual.
Deudas Actuales
Por favor enumere todas sus deudas sin garantía con saldos superiores a $100. No incluya préstamos hipotecarios, automotrices o
estudiantiles. Detalle estas deudas en las categorías correspondientes de la página anterior de información sobre gastos. Por favor
tenga en su poder durante la sesión de asesoramiento su declaración crediticia actual.
Nombre del Acreedor
Número de Cuenta
Saldo Actual
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
SOLAMENTE PARA EL USO DEL CONSEJERO
Client Number
Results
Proposed Deposit
Date Counseled
Counselor
Notes
Pago Actual
Tasa de
Interés
Meses de
Atraso
Acuerdo para los Servicios de Asesoramiento
Por favor, lea las siguientes declaraciones con atención. Escriba sus iniciales en la línea que está junto a cada
declaracíon para indicar su entendimiento. (El singular se usa incluso cuando pueda aplicarse la forma plural).
_____ Entiendo que la agencia proveerá una consulta confidencial sobre administración del dinero personal, vivienda
y/o informe de crédito, después de la cual recibiré un plan de acción por escrito que detallará las recomendaciones
para manejar mis finanzas y que posiblemente incluirá referencias a otros servicios y agencias, según corresponda.
_____ Entiendo que la mayoría de los fondos del CCCS proviene de contribuciones voluntarias de los acreedores que
participan en el Plan de manejo de deudas (DMP, Debt Management Plan). Dado que los acreedores tienen un
interés financiero en que se les pague, la mayoría está dispuesta a hacer una contribución para ayudar a financiar
a CCCS. Estas contribusiones por lo general se calculan como un porcentaje de los pagos que yo haga a través
de mi DMP – hasta un (15% de cada pago recibido. Sin embargo, mis cuentas con mis acreedores siempre se
acreditarán en el cien por ciento (100%) del importe que yo pague. La ausencia de la contribución de un acreedor
no afectará la disposición de CCCS de trabajar con ese acreedor.
_____ Entiendo que si elijo iniciar un DMP, mi participación puede afectar mi puntaje y mi informe de crédito, según las
políticas de mis acreedores con respecto al DMP y mi historial de pagos anterior a, y durante, mi participación en
un DMP. Un DMP podría tener un impacto negativo sobre la decisión que un potencial acreedor, un propietario
o empleador tome en el futuro, respecto del mérito de otorgarme el crédito. Por otro lado, los acreedores pueden
informar que yo estoy en un DMP y que no estoy pagando como me había comprometido originalmente, aunque
ellos hayan aceptado recibir un pago menor. La agencia no tiene ninguna responsabilidad o obligación alguna
por ninguna calificación de crédito pasada, presente o futura que yo reciba. El DMP incluirá mis deudas no
garantizadas y puede incluir ciertas deudas garantizadas.
_____ Entiendo que si bien un DMP puede ser una opción disponible el repago de mis deudas, no es una opción
adecuada para todos los clientes. Entiendo que mi asesor discutirá todas mis opciones para resolver mi situación.
Entiendo que el hecho de recibir servicios de asesoramiento financiero no garantiza automáticamente que
participaré en los servicios del DMP.
_____ Entiendo que, en caso de que así lo permita la ley estatal, el establecimiento de un DMP derivará en una cuota
de educación sobre el DMP, que se exige antes de la implementación del mismo y en un cuota administrativa
mensual que se cobrará posteriormente. Entiendo que los servicios prestados no son contingentes al pago de
dichos cuotas.
_____ Un asesor puede responder preguntas y suministrar información sobre quiebras (bancarrotas), pero no brinda
asesoramiento legal. Si necesito esta clase de asesoramiento, me referiron a un profesional adecuado. Si bien
un abogado puede recomendar que se presente la quiebra (bancarrota), ésta es una opción personal basada en
circunstancias individuales.
_____ Yo podría ser referidora a otros servicios de la organización o a otra agencia o agencias según resulte apropiado
que puedan asistir me con los problemas particulares que se hayan identificado. Entiendo que no tengo la
obligación de usar ninguno de los servicios que se me ofrecen. Entiendo que CCCS provee informacion y
educacion en numerosos productos de prestamos y programas de vivienda, y entiendo tambien que la consejeria
de vivienda que reciba de CCCS de ninguna manera me obliga a escoger cualquiera de estos prestamos o
programas de vivienda.
_____ En algún momento futuro, mi información se puede usar para una investigación confidencial y/o un tercero
imparcial puede contactarme para solicitar una evaluación de los servicios de la agencia.
_____ Entiendo que en el casode que yo este insatisfecho, puedo utilizar el Proceso de resolución de quejas, cuya copia
está disponible a solicitud.
_____ Entiendo que a menos que yo prefiera “optar por excluirme”, la agencia – si así se lo solicitan mis acreedores –
puede verificar mi cita, así como también la fecha y los resultados de la misma. Asimismo entiendo que tengo
el derecho de “optar por excluirme” de que se comparta mi información llamando a la línea de “opción de
exclusión” CCCS, (888-440-4663) tal como se establece en la Política de Privacidad CCCS.
_____ Entiendo que mi consejara ha completado un programa interno de formancion desarrollado poer CCCS, y had
recibido, dentro del primer ano de consejeria en CCCS, la certification de Consejero de Credito al Consumuidor
otorgada a traves de un programa de certificacion desarrollado por la Fundacion Nacional de Consejeria de
Credito, en coordinacion con Purdue Unviversity. Asimismo, en el primer ano de assesoramiento, mi consejero
ha obtenido el titulo de Revisar Certificado de Reportes de Credito, y una acreditacion de Entrevistadoe al
Consumidor ototgada por la Industria de Asociacion de Datos del Consumidor.
_____ Yo autorizo a la agencia a acceder a mi reporte de credito para verificar mi cuenta y para una investigacion
confidencial en el futuro. Entiendo que el acceso a estos informes no tendra un efecto prejudicial sobre me puntaje
de credito.
RESIDENTES DE ILLINOIS:
_____ La Ley de Servicios de Manejo de Deudas se administra a través del Departamento de Instituciones Financieras de
Illinois.
RESIDENTES DE CALIFORNIA:
_____ Las quejas referidas al presente acuerdo pueden presentarse al Departamento de Sociedades de California. Esta
organización de servicios a la comunidad sin fines de lucro ha adoptado las mejores prácticas para los planes de
manejo de deudas y los planes de cancelación de deudas, cuya copia puede obtenerse a pedido.
Cliente__________________________________________________________
Fecha___________________
Cliente__________________________________________________________
Fecha___________________
Asesor__________________________________________________________
Fecha___________________
El Servicio de asesoramiento de crédito para el consumidor de San Francisco presta los siguientes servicios sin cargo a
los consumidores de toda la nación:
•
•
•
•
•
Asesoramiento sobre administración del dinero
Asesoramiento sobre la vivienda
Talleres prácticos
Fuentes de referencia
Biblioteca de materiales educativos
El servicio de asesoramiento de crédito para el consumidor de San Francisco ofrece los siguientes servicios por una
pequeña cuota:
•
Planes de manejo de deudas: cuota única de $45 de educación sobre el programa; $35 como cuota arancel mensual máxima, cuando así lo permita la ley estatal
Horario de atención: de Lunes a Jueves, de 8:00 a.m. a 8:00 p.m.; Viernes y Sábados, de 8:00 a.m. a 5:00 p.m.
CCCS-SF es un servicio sin fines de lucro brindado a la comunidad en
asociación con la fundación nacional para asesoramiento crediticio.
(REV 0710)
Declaración de Privacidad
Consumer Credit Counseling Service of San Francisco (“CCCSSF”) está comprometido a garantizar la privacidad
de las personas y/o de las familias que nos han contactado para solicitar asistencia. Estamos concientes de que las
preocupaciones que usted nos plantea tienen una naturaleza altamente personal. Le aseguramos que toda la información
compartida por vía oral y por escrito se manejará dentro del marco legal y ético. Su “información personal no pública”,
como por ejemplo, los datos sobre su deuda total, los ingresos, los gastos de subsistencia y la información personal
referida a su situación financiera se suministrará a los acreedores y a otras personas sólo con su autorización. También
podemos utilizar información del expediente agregada en forma anónima para evaluar nuestros servicios, recabar datos
valiosos de investigación y diseñar futuros programas.
Tipos de información que colectamos sobre usted
• Información que recibamos de usted verbalmente, sobre las solicitudes u otros formularios, tales como su
nombre, domicilio, número de seguro social, activos e ingresos;
•
Información referida a las transacciones que efectúe con nosotros, sus acreedores u otros, tales como el
saldo de su cuenta, sus antecedentes de pago, las partes que intervienen en las transacciones y el uso de las
tarjetas de crédito; e
•
Información que recibamos de una agencia de informes de crédito, como por ejemplo, su historial de
crédito.
SÓLO ASESORAMIENTO
Usted puede ejercer su derecho de exclusión respecto de ciertas divulgaciones
1.Usted tiene la oportunidad de pedir que lo “excluyan” de las divulgaciones de su información personal confidencial
a terceros (como por ejemplo, sus acreedores), es decir, darnos instrucciones para que no hagamos esas
divulgaciones.
2. Si usted opta por la “exclusión”, no podremos responder las preguntas de sus acreedores. Si en cualquier
momento, usted desea cambiar su decisión con respecto al derecho de “exclusión”, puede llamarnos al
(888) 440-4663 y hacerlo.
3. Si usted no hubiera optado por la “exclusión”, confirmaremos a sus acreedores si nos solicitan:
•
•
•
La verificación de una cita con nosotros
La fecha de asesoramiento
La disposición: por ejemplo
– Usted manejará sus asuntos por medios propios
– Acción pendiente (como el Programa de gestión de deudas)
Divulgación de su información a terceros
1.Siempre y cuando usted no haya optado por la exclusión, podemos divulgar parte o toda la información que
recibamos, como se describiera anteriormente, a sus acreedores o a terceros en caso de que determinemos que sería
beneficioso para usted o que nos serviría para asesorarle.
2. Por lo general suministraremos sólo la siguiente información a sus acreedores si nos lo piden:
•
•
•
La verificación de una cita con nosotros
La fecha de asesoramiento
La disposición: por ejemplo
– Usted manejará sus asuntos por medios propios
– Acción pendiente (como el Programa de gestión de deudas)
3. Podemos compilar datos y acumular información que usted nos suministre, pero esta información no puede
ser divulgada de una manera que le identifique en ningún aspecto.
4. Restringimos el acceso a la información personal no pública sobre usted a aquellos empleados que, en
nuestra opinión, necesiten conocer esa información para prestarle servicios. Mantenemos resguardos
físicos, electrónicos y de procedimiento para proteger su información personal no pública.
5. También podemos divulgar información personal no pública acerca de usted o de ex clientes a cualquier
persona que la ley permita (por ejemplo, si estamos obligados por un proceso legal).
PARA LOS CLIENTES QUE PARTICIPEN EN UN PROGRAMA DE GESTIÓN DE DEUDAS
1.
Si necesita intervención para que le representen frente a los acreedores, a través de un Programa de gestión
de deudas u otro similar, obtendremos su consentimiento expreso para divulgar a los acreedores la
información personal no pública acerca de usted. No podremos asistirle con un Programa de gestión de
deudas si usted no nos otorga su consentimiento para compartir información con sus acreedores
2. Restringimos el acceso a la información personal no pública sobre usted a aquellos empleados que, en
nuestra opinión, necesiten conocer esa información para prestarle servicios. Mantenemos resguardos
físicos, electrónicos y de procedimiento para proteger su información personal no pública.
3. También podemos divulgar información personal no pública acerca de usted o de ex clientes a cualquier
persona que la ley permita (por ejemplo, si estamos obligados por un proceso legal).
La Casa De Las Madres Credit Counseling Pilot
Demographic Information
Age
Disability (yes/no/type)
Ethnicity
Family size/kids yes or no/pregnant yes or no
Primary language/limited english/fluency in english
Gender
Sexual Orientation
Type of housing
Zip code
Annual income
Employment status
Income source
Medical Insurance (yes or no)
Military Service (yes or no)
Financial
Primary Cause Of Financial Problem (Percentage Breakdown)
Gender (Percentage Breakdown)
Ethnicity (Percentage Breakdown)
Average FICO Score
Average Monthly Housing Expenses
Average Monthly Living Expenses
Average Total Unsecured Debt
Average Monthly Unsecured Debt Payment
Average Number of Unsecured Creditors
Average Total Assets
Average Total Liabilities
Average Total Savings
Financial Education
Supporting Documents
Financial Education Workshops Budgeting and Saving Banking Basics Importance of Goal Setting Saving Money and Creating a Spending Plan By the end of the class, participants will have outlined things to look for in a savings or checking account and discussed local options (banks and credit unions) By the end of the class, participants will have defined a Specific, Measurable, Achievable, Results Oriented, and Time-­‐bound (SMART) goal and sketched a goal of his/her own By the end of the class, participants will have outlined ways to save money and identified ways to cut expenses in his/her household. By the end of the class, participants will create a spending plan and budget Credit Reports and Access to Credit Introduction to Credit Credit Reports and Identify Theft Understanding credit cards and credit lines By the end of the class, participants will have defined what credit is, discussed when to use credit & not to use credit, determined their debt-­‐to-­‐
income ratio By the end of the class, participants will have reviewed a sample credit report & determined how to correct errors and discussed tips on how to improve credit scores identified resources to help them with any credit issues By the end of the class participants will have described what to look for in a credit card calculated the cost of paying the minimum balance Financial Pitfalls to Avoid and Financial Resources Five Financial Pitfalls to Avoid Facing Obstacles in the Way of Meeting Your Goal Resources By the end of the class, participants will have an understanding of the true cost of using fringe financial services such as Check Cashers, Pay Day Lenders, Rent to Own, Refund Anticipation loans, etc. By the end of the class, participants will have outlined obstacles that might arise as they work toward their asset goals and identified ways to plan for those issues By the end of the class, participants will have an outline of asset building resources and services that are free, and easily accessible through public transportation. These resources are meant to help participants take their next step towards achieving their goals La Casa de las Madres:
Taller de Educación Económico
Julio 2013
Por favor marque Ud. con un círculo la respuesta apropiada:
► Tengo
una buena comprensión de mis opciones bancarias.
Nada
1
► Tengo
Un poco
2
Bastante
3
Mucho
4
Un poco
2
Bastante
3
Mucho
4
una buena comprensión de informes de crédito y puntajes de crédito FICO
Nada
1
► Tengo
Mucho
4
una buena comprensión de crédito.
Nada
1
► Tengo
Bastante
3
una buena comprensión de la importancia de un presupuesto.
Nada
1
► Tengo
Un poco
2
Un poco
2
Bastante
3
Mucho
4
una buena comprensión de los recursos comunitarios de ayuda financiera.
Nada
1
Un poco
2
Bastante
3
Mucho
4
La Casa de las Madres:
Taller de Educación Económico
Fecha
Por favor marque Ud. con un círculo la respuesta apropiada:
► Debido a este serie de talleres, siento que tengo una comprensión mejor de mis opciones bancarias.
Nada
Un poco
Bastante
Mucho
1
2
3
4
► Debido a este serie de talleres, siento que tengo una comprensión mejor de la importancia de un
presupuesto.
Nada
Un poco
Bastante
Mucho
1
2
3
4
► Debido a este serie de talleres, siento que tengo una comprensión mejor de crédito.
Nada
Un poco
Bastante
Mucho
1
2
3
4
► Debido a este serie de talleres, siento que tengo una comprensión mejor de informes de crédito y puntajes
de crédito FICO
Nada
Un poco
Bastante
Mucho
1
2
3
4
► Debido a este serie de talleres, siento que tengo una comprensión mejor de los recursos comunitarios de
ayuda financiera.
Nada
Un poco
Bastante
Mucho
1
2
3
4
► Debido a este taller me siento que he sido capaz de explorar y entender mejor mi relación con el dinero.
Nada
Un poco
Bastante
Mucho
1
2
3
4
► Sobretodo, considero que este taller me ha ayudado a aumentar mi conocimiento en relación a cuestiones
financieras
Nada
Un poco
Bastante
Mucho
1
2
3
4
► Siento que he aprendido hoy las cosas que voy a utilizar para mejorar mi situación financiera..
Nada
Un poco
Bastante
Mucho
1
2
3
4
1. P
1. Cuantos sesiones asistió Ud. de este taller
1
2
3/todos
2. Por favor, use Ud. este espacio para decirnos la cosa más ayudosa o
importante que ha aprendido durante este taller.
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
3. Por favor, use Ud. este espacio para añadir cualquier otro comentario o
sugerencia para futuras presentaciones. Gracias.
______________________________________________________________
______________________________________________________________
______________________________________________________________
______________________________________________________________
Outreach
Supporting Documents
IT’S
EVERYTHING
YOU NEED
TO KNOW
ABOUT
MONEY.
La Casa De Las Madres Financial Coaching
Be financially empowered.
La Casa De Las Madres has partnered with the San
Francisco Office of Financial Empowerment and
Consumer Credit Counseling Service of San Francisco to
provide up to 30 La Casa clients with the opportunity
to work one -on-one with a certified financial counselor
for FREE.
It is free to participate but clients will be asked to
complete two to three one-on-one couseling sessions
with a certified credit couselor, attend five hours of
financial education workshops at a site that is convenient to
you and also complete a few simple surveys.
Space is limited so register soon!
To register and for more information, speak to:
Lindsay Sweetnam | Program Director
415-503-0500 x 309 | [email protected]
Work on topics of your choice:
Create a Budget
Increase your Savings
Improve your Credit Score
Understand Bankruptcy
Understand Foreclosures
Reduce your Debt
Understand your Credit Report
Learn about Homeownership
Open a Bank Account
Create a Financial Action Plan
and much more!
Todo
que
necesita
saber
sobre
el dinero.
La Casa De Las Madres
Proyecto de Educación Financiera
Trabaje con las temas de su
La Casa De Las Madres se ha asociado con San Francisco
interes:
Office of Financial Empowerment y Consumer Credit
Counseling Service de San Francisco para ofrecerle a
un máximo de 30 clientes de La Casa con la oportunidad
- Creación de un presupuesto
de trabajar uno a uno con un experto financiero de forma
- El aumento de sus ahorros
gratuita.
- Mejorar su puntaje de crédito
Es gratis para participar, pero los clientes deben ponerse
- Comprensión de Bancarrota
de acuerdo para completar dos a tres sesiones con un
- Comprensión de ejecuciones
consejero de crédito, asistir a cinco horas de talleres de
hipotecarias
educación financiera y completar algunas encuestas.
- La reducción de la deuda
Para inscribirse y obtener más información,
por favor hable con:
Lindsay Sweetnam | Program Director
415-503-0500 x 309 | [email protected]
- Comprensión de su informe de
crédito
- Aprender sobre propiedad de
vivienda
- Apertura de una cuenta bancaria
- Y mucho más.
La Casa De Las Madres Financial Coaching Service Project
Be financially empowered
La Casa De Las Madres has partnered with the San Francisco Office of Financial Empowerment and
Consumer Credit Counseling Service of San Francisco to provide up to 30 La Casa clients with the
opportunity to work one on one with a certified financial counselor for FREE.
It is free to participate but clients will be asked to complete two to three one-on-one counseling
sessions with a certified credit counselor, attend five hours of financial education workshops at a site
convenient to you and complete a few simple surveys.
Work one-on-one with an expert on your choice of topics, such as:
-
Creating a Budget
Increasing your Savings
Improving your Credit Score
Understanding Bankruptcy
Understanding Foreclosures
-
Reducing Debt
Understanding Your Credit Report
Learning about Homeownership
Opening a Bank Account
And much more.
To register and for more information, please speak to:
Lindsay Sweetnam | Program Director|La Casa De Las Madres |415-503-0500 x 309|[email protected]
Client Agreement
Please read the following statements carefully. Initial the line next to each statement to indicate
understanding.
___ I understand that this is a voluntary program and that all identifying information will remain
confidential.
___ I agree to participate in 2-3 one-on-one counseling sessions with Consumer Credit Counseling
Service of San Francisco. Counseling session can be completed between August 2013-April 2014.
___ I agree to participate in five hours of financial education to be held at La Casa and other nearby
locations. Financial Education workshops can be completed between August 2013 and April 2014.
___ I understand that I will be asked to complete surveys throughout the program on my financial
standing. The goal of the survey will be to assess the effectiveness of the counseling sessions and
workshops . All identifying information in the surveys will remain confidential.
___ I understand that in order to receive services I will be working with Consumer Credit Counseling
Service of San Francisco to schedule my one-on-one appointments and use the code word “Office of
Financial Empowerment” to receive free services.
Client Name________________________________________
Date______________________________________________
La Casa De Las Madres – Proyecto de Educación Financiero
La Casa De Las Madres se ha asociado con San Francisco Office of Financial Empowerment y
Consumer Credit Counseling Service de San Francisco para ofrecerle a un máximo de 30 clientes
de La Casa con la oportunidad de trabajar uno a uno con un experto financiero de forma
gratuita.
Es gratis para participar, pero los clientes deben ponerse de acuerdo para completar dos a tres sesiones
con un consejero de crédito, asistir a cinco horas de talleres de educación financiera y completar algunas
encuestas.
Trabaje uno-a-uno con un experto en las temas cualquier tema que le interesa:
- Creación de un presupuesto
- El aumento de sus ahorros
- Mejorar su puntaje de crédito
- Comprensión de Bancarrota
- Comprensión de ejecuciones hipotecarias
- La reducción de la deuda
- Comprensión de su informe de crédito
- Aprender sobre propiedad de vivienda
- Apertura de una cuenta bancaria
- Y mucho más.
Para inscribirse y obtener más información, por favor hable con:
Lindsay Sweetnam | Directora de Programas |La Casa De Las Madres |415-503-0500 x 309
|[email protected]
_______________________________________________
Acuerdo con el Cliente
Por favor, lea atentamente las siguientes declaraciones. Inicial de la línea al lado de cada declaración
que indique comprensión.
___ Entiendo que este es un programa voluntario y que toda la información de identificación será
confidencial.
___ Estoy de acuerdo en participar en 2-3 sesiones de asesoramiento con Consumer Credit Counseling
Service de San Francisco. Sesión de asesoramiento puede ser completada entre agosto 2013 a abril
2014.
___ Estoy de acuerdo en participar en cinco horas de educación financiera que serán en La Casa y de
otras localidades cercanas. Talleres de educación financiera pueden completarse entre agosto de 2013 y
abril de 2014.
___ Entiendo que me pedirán que complete encuestas en todo el programa en mi situación financiera.
El objetivo del estudio será evaluar la efectividad de las sesiones de consejería y talleres. Toda la
información de identificación en las encuestas se mantendrá confidencial.
___ Entiendo que para recibir los servicios que va a trabajar con Consumer Credit Counseling Service de
San Francisco para programar mis uno-a-uno citas y usar la palabra clave "Office of Financial
Empowerment " para recibir servicios gratuitos.

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