Financial Wellness Peer Education Appointment Form

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This form serves as the initial step to starting a peer education relationship with the University of Illinois Extension. Please fill out each section and complete with your best ability. Any questions please direct them to Brooke Shrewsbury, Program Coordinator, at bhaag2@illinois.edu.

Name *

First and Last Name

Email Address *

How do you want to meet with Peer Educators? *

Please select one

In Person

Phone

Other:

Schedule Your Appointment *

Please select your preferred time to meet (1st preference)

YYYY

Time

Schedule Your Appointment *

Please select your prefered time to meet (2nd preference)

YYYY

Time

Main topics that you would like to discuss with Peer Educators. *

List each issue you need assistance with.

Which area do you want to improve or need assistance? *

Select all that apply

Goal Setting/Planning

Savings Plan

Financial Account Assistance

Credit Worthiness Improvement

Credit Card Questions

Credit Report

Student Loan

Retirement Plan

Keep Track of Expenses

Bill Paying Strategies

Develop A Budget

Other:

Submit

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