Online Assessment Form Introduction & Consent

SECURITY WARNING:  if you are using this service on a shared computer in a public area (i.e. public kiosk or library), please ensure that you do not leave the computer unattended while accessing this service.  Before leaving the computer, it is also important that you fully log out of the application, clear your browser’s cache and close down your browser.  These precautions ensure that no one else can access any personal information you may have entered.

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Welcome to Credit Counselling Service of Simcoe County.  We recognize that you have taken a big step toward improving your financial situation and we hope to be of some help to you.  The decision to seek counselling may have been a difficult one and we commend you.

Credit Counselling of Simcoe County has been serving the area since 1973.  We are an accredited member of the Ontario Association of Credit Counselling Services (OACCS) and, as such, adhere to its standards and guidelines.  The OACCS Accreditation Committee reviews our policies and procedures on a regular basis to ensure that we continue to meet these standards.

We are a not-for-profit agency.  Our funding comes from sources including the United Way, private donations and service fees.

All information you give us is kept strictly confidential and is protected in accordance with Canada’s Personal Information Protection and Electronic Documents Act (PIPEDA).  Other than confirming that you have filled out the attached (if asked), we will not release any information regarding your file without obtaining your written authorization (unless required by law).  This includes personal information as defined in PIPEDA.  By agreeing to this document you consent to the collection of your personal information including details of your financial history.  You also consent to its use by the Agency to help in the assessment of your financial situation and other administrative purposes including: filing, record keeping and processing.

Your personal information may, from time to time, be delivered to third parties as part of your program.  By agreeing to this form you acknowledge that you have been advised that in such a case the Agency will request that you sign specific consents that outline the purposes for passing your personal information along to third parties.

You have the right to review your file in the presence of your Counsellor or the Agency’s Privacy Officer, Executive Director and request that any incorrect information be corrected.  You also have the right to file a complaint about the services rendered by the Agency, or to appeal a decision you consider unsatisfactory.  Further information regarding our appeal process is available from our staff.

In conformity with applicable legislation, we have developed our privacy policy, which appears on our web site at www.ccsbarrie.net.  We will from time to time, review and revise our policy, and in the event of any amendments, a notice will be posted on our web site.  Policy changes will apply to the information collected from the date of the posting as well as to existing information held by us.


I/We acknowledge receipt of this information and affirm/agree to disclosing my/our personal information for the purposes outlined above.

I acknowledge that I understand that certain personal information will be collected by Credit Counselling Service of Simcoe County including financial details, in order for me to participate in its credit counselling program.  I have been advised that this personal information will be specifically used to open a file with the Agency.