Third-Party Release of Information
I, (
print name) _________________________, authorize the following individual or organization
to complete this application on my behalf, including submitting necessary documentation,
speaking, and communicating via text, chat, or email with representatives of the RRP Support
Center, Virginia Housing, and/or the Virginia Department of Housing and Community
Development.
_______________________________ _________________________________________
Print First/Last Name of Third-Party Print Third Party’s Organization Name
(if applicable)
____________________________
______________________________________
Date Preferred Language (Spoken / Written)
____________________________
_______________________________________
Cell phone Email
