Financial Empowerment Program

Saturdays - September 19 - October 24, 2026 - 10:00 AM - 1:00 PM

Join A Hand Up Community Resource Center for a six-week financial empowerment series designed to help individuals and families build a stronger financial future. Topics include budgeting, saving, banking, credit, debt reduction, taxes, investing, financial scams, and long-term financial planning.

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1. REGISTRATION DATE (Required.)

Date

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2. FIRST NAME (Required.)

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3. LAST NAME (Required.)

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4. STREET ADDRESS  (Proof of Residency is Required) (Required.)

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5. PREFERRED METHOD OF CONTACT (Required.)

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6. Preferred Language (Required.)

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7. GENDER (Required.)

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8. WHICH RACE/ETHNICITY BEST DESCRIBES YOU? (Please choose only one.) (Required.)

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9. MARITAL STATUS (Required.)

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10. ARE YOU A VETERAN OR ACTIVE MILITARY? (Required.)

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11. HOW MANY PEOPLE CURRENTLY LIVE IN YOUR HOUSEHOLD? (Required.)

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12. ARE YOU CURRENTLY EMPLOYED?  (If the application is approved you will be asked to provide 2 recent paycheck stubs) (Required.)

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13. DO YOU CURRENTLY RECEIVE SOCIAL SECURITY OR SSI BENEFITS? (If your application is approved, you will be asked to provide a letter stating the amount) (Required.)

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14. DO YOU RECEIVE ADDITIONAL INCOME FROM ANY OF THESE SOURCES? 
(If your application is approved you will be asked to provide a letter stating the amount) (Required.)

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15. WHAT IS YOUR TOTAL CURRENT MONTHLY HOUSEHOLD INCOME AFTER TAXES? (Required.)

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16. WHICH OF THE FOLLOWING BEST DESCRIBES YOUR CURRENT FINANCIAL GOALS? (Required.)

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17. WHAT DO YOU CONSIDER YOUR BIGGEST FINANCIAL CHALLENGE TODAY? (Required.)

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18. HOW CONFIDENT DO YOU FEEL MANAGING YOUR PERSONA FINANCES? (Required.)

Not confident Somewhat confident Very confident
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i We adjusted the number you entered based on the slider’s scale.

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19. WHAT DO Y0U HOPE TO GAIN IN THIS PROGRAM? (Required.)

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20. HAVE YOU EVER CREATED A WRITTEN BUDGET? (Required.)

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21. IF YOU COULD ASK A FINANCIAL EXPERT ONE QUESTION, WHAT WOULD IT BE? (Required.)

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22. PROOF OF HOUSEHOLD INCOME DOCUMENTATION: For EACH source of income in the household, you will need ONE of the following, dated in the last three months:
*Pay stubs (must be consecutive and cover at least 30-45 days).
*Benefit award letters or statements (such as unemployment compensation printout, worker's compensation award, Social Security, disability, pension, or welfare benefits).

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23. DO YOU HAVE ACCESS TO A WI-FI CONNECTION? (Required.)

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24. ARE THERE ANY SPECIFIC ACCOMMODATIONS NEEDED? (Required.)

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25. HOW DID YOU HEAR ABOUT THE PROGRAM? (Required.)

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26. DO YOU GIVE A HAND UP COMMUNITY RESOURCE CENTER PERMISSION TO USE YOUR PHOTO, LIKENESS, AND/OR WORDS IN ONGOING PROMOTIONS AND ADVERTISEMENTS ABOUT THE PROGRAM? (Required.)

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27. By typing my full name below, I certify that the information provided on this application is true and complete. I understand that I am applying for the Fall 2026 Road to Financial Freedom Financial Empowerment Program sponsored by A Hand Up Community Resource Center, Inc. I understand that submitting this application does not guarantee acceptance into the program. I authorize A Hand Up Community Resource Center to verify information provided when necessary for program eligibility. (Required.)

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28. Thank you for your desire to participate in our program. We will contact you in the next 72 hours to regarding your application. If you have additional questions, please email us at info@ahandupcrc.org or call 502-438-8102.

Please note: If you are unable to attend the first session, your seat in the class may be forfeited. (Required.)

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