Personal Finance Seminar Application

Please note that your responses to any and all of the following questions WILL NOT disqualify you from participating in the Financial Class. Leaders will keep all personal information disclosed on this form confidential.

"*" indicates required fields

GENERAL INFORMATION

Name*

First Last

Address*

Street Address Address Line 2 City State ZIP Code

Phone*

Email*

Referring Agency from Hazel's House of Hope:*

Please list any food allergies or special requests.*

Please list any medical restrictions or other special needs.*

WORK STATUS

Are you currently employed?*

Yes

If not, are you seeking employment?*

Yes

Are you a current recipient of government assistance?*

Yes

Monthly Income*

What are your reasons for taking our financial seminar?*

If you have a present financial goal or objective, what is that goal?*

MOST interesting*

SECOND most interesting*

THIRD most interesting*

LEAST interesting*

Is there anything else you'd like to learn?*