Financial Coaching Application

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Thank you for your interest in United Way's Financial Coaching program. Here's how it works:

Step 1: Complete this online application. Enrollment periods are May and November of each year. If you apply outside of these timeframes, we will contact you during the next enrollment period.

Step 2: Pay a $20 refundable enrollment deposit to enter the program. The fee can be paid by cash or check only.

Once your enrollment deposit has been paid, you will be matched with a professional financial coach for the twelve-month program. You will get a $20 refund check at the completion of 12 months of coaching.

Are you ready to Reach Your Goal$? If so, please continue!

First Name *

Last Name *

Street Address (We will be sending you mail) *

City *

Zip Code *

Phone number *

Alternate Phone number

Email address (We will send you important emails) *

How did you hear about this program? *

What is your employment status? *

Full time

Part time

Student

Retired

Disabled

What is your main source of income? *

Wages from a job

Child or spousal support

Retirement income

SSI/SSDI

Other:

Do you own a vehicle? *

Yes

Do you own or rent your home? *

Own

Rent

In temporary housing

What are your financial goals? (Check all that apply) *

Saving money

Paying-off Debt

Investing

Increasing my Income

Improving my Credit Score

Saving for a big purchase

Other:

Required

Do you have a bank account?

Checking account only

Savings account only

Checking and Savings

No, I don't have a bank account

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