Certification and Authorization for Release of Information

By clicking “Submit”:

(1) I certify that the information that I have provided in this Application for Supportive Services is true, accurate, and complete, to the best of my knowledge.  I understand that misrepresentation, falsification, or omission of information could disqualify me from receiving Supportive Services, and that I may be asked to provide documentation verifying the statements that I have made.

(2) I authorize USO to receive, maintain, and release the foregoing information — and any additional information that I choose to provide to USO— to other organizations and individuals who are involved in assisting in the delivery of the requested Supportive Services.  I understand and accept the risk that any disclosure of information carries with it the potential for unauthorized re-disclosure.  This Authorization for Release of Information shall remain in effect unless I revoke such authorization in writing, which I may do at any time, except to the extent that such information has already been disclosed.