Application Data & Financial Information Disclosure – Hope Village


Application Data & Financial Information Disclosure

Hope Village Retirement Community  |  1535 S Ivy St, Canby, OR 97013
Effective Date: September 3, 2026

This notice explains how Hope Village collects, uses, and protects the information you submit as part of a Cottage Home or Garden Home residency application. Please read it before completing the form.

Why We Ask for Financial Information

Hope Village is a not-for-profit Life Lease community. Prospective residents must demonstrate that they meet minimum income and asset requirements before being offered a home. The financial information you provide is used exclusively for this eligibility determination and for no other purpose.

What This Form Collects

  • Full legal name(s) and date(s) of birth
  • Current mailing address, phone number, and email address
  • Emergency contact details for two contacts
  • Residency preference: Cottage Home or Garden Home, floor plan, desired move-in date
  • Assets: savings, checking, CDs, securities, retirement accounts (IRA/401k), real estate values
  • Liabilities: current debt, notes payable, mortgage balances, property taxes
  • Monthly income: annuities, dividends, pension, Social Security, other income
  • Monthly expenses: auto, food/clothing/entertainment, medical, insurance, utilities
  • Life insurance coverage and beneficiary arrangements
  • Digital signature certifying age eligibility and accuracy of information
What we do NOT collect: We do not ask for Social Security numbers, driver’s license or ID numbers, passport numbers, or any other government-issued identification.

Who Has Access

  • Tina Schimpf , Housing and Resident Services Manager — primary reviewer | tina@hopevillage.org
  • Larissa Tiede, Executive Director — authorized administrative staff | larissa@hopevillage.org
  • Boxed Gorilla LLC (contracted website administrator) — access limited to technical maintenance only; does not review application content | info@boxedgorilla.com

Your application data is never shared with Marquis Assisted Living, marketers, advertisers, or any external parties except as required by law.

How Your Application Is Stored

  • Stored in a secured, access-controlled system within the website backend
  • Staff are notified of new submissions by email and access data through authenticated login
  • All data transmitted through this form uses SSL/TLS encryption

If you prefer not to submit financial information online, call (503) 266-9810 to request a paper application.

How Long We Keep Your Information

  • Active applicants and waitlist: Retained for the duration of your active interest. Waitlist records are reviewed annually each September.
  • Declined applications: Retained for 12 months following a final decision, then permanently deleted.
  • Withdrawn applications: Deleted upon your written request.

Your Rights

At any time you may request a copy of your information, request a correction, or withdraw your application and have your data deleted. Contact Larissa Tiede:

Age Eligibility

All residents must be 62 years of age or older at the time of move-in. By submitting this application you are certifying that you — and your co-applicant, if applicable — will meet this requirement by your desired move-in date. Date of birth is collected solely to verify eligibility.

Accuracy of Information

By submitting this application you certify that all information provided is complete and accurate to the best of your knowledge. Submission of materially false information may result in disqualification of your application or, if discovered after move-in, may constitute grounds for lease termination.

Questions

Contact us before submitting if you have any questions about how your information is handled:

For our full site-wide privacy practices, see our Privacy Policy.