Financial Education Registration Form

Dependent Information:

Do you have any of the following:
If the workshop is scheduled for 3 days you must attend all 3 days in order to complete the class and obtain the certificate
Household Information

Information of Children
AgeGenderEthnic GroupRaceDisabledEmployedInSchoolAction
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Financial Management
Activites Log
Activity DateActivity TypeNoteAction
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Action Plan
Desired Outcomes

Credit Score
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Established a budget
Established a banking relationship
Established or Increased Savings
Reduced long term
Reduced short term debt
Paid Judgement
Child support current
Cleared closed accounts
Paid Collections
Paid Medical Collections
Paid liens
Corrected inaccurate information
Established traditional credit
Established non-traditional credit
Established Investments
Paid off payday lenders
Purchased Asset
Opened an IDA
FM Summary
Initial Credit Card Debt
Updated Credit Card Debt
Update Credit Card Date
Initial Installment Loan Debt
Updated Installment Loan Debt
Update Installment Loan Date
Initial Mortgage Debt
Updated Mortgage Debt
Updated Mortgage Date
Initial Student Loan Amount
Updated Student Loan Amount
Update Student Loan Date
Initial Line of Credit Debt
Updated Line of Credit Debt
Update Line of Credit Date
Initial Medical Amount
Updated Medical Amount
Update Medical Date
Initial Check System Debt
Updated Check System Debt
Update Check System Date
Initial Payday Lender Amount
Updated Payday Lender Amount
Update Payday Lender Date
Initial Buy here Debt
Updated Buy here Debt
Update Buy here Date
Initial Collection Amount
Updated Collection Amount
Update Collection Date
Initial Judgment Amount
Updated Judgment Amount
Update Judgment Date
Initial Charge off Amount
Updated Charge off Amount
Update Charge off Date
Initial Child Support Amount
Updated Child Support Amount
Update Child Support Date
Initial Debt Repayment I
Updated Debt Repayment I
Update Debt Repayment I
Initial IRS Debt
Updated IRS Debt
Update IRS Date