Cabarrus Financial Empowerment Forum

Section 1: Registration and Financial Wellness Scoring

Locations and Time:
Neighborhood Networks Technology Center

265 Salem Street, SW

Concord, NC 28025

Date: March 10, 2026

Time: 6:00 - 7:30 pm

Please arrive by 5:45 pm to get signed in. Have paper and pen available for notes.

READ CAREFULLY ABOUT THE SCORING:
Scores above 50% indicates that you may want to consider a Financial Wellness Session to identify areas of concerns to be tuned up for long-term financial sustainability.

We look forward to assisting you.

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* 1. Participant Information - Please include First and Last name

Name

Address

City/Town

State

ZIP/Postal Code

Email Address

Phone Number

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* 2. Co-participant Information - Please provide First and Last Name

Name

Address

City/Town

State

ZIP/Postal Code

Email Address

Phone Number

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* 3. Which location will you be attending?

Neighborhood Networks Technology Center - 265 Salem Street, SW, Concord, NC 28025

Hybrid Option - Please send Zoom Link (make sure we have correct email address as Zoom link will be emailed to you)

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* 4. Are you interested in home purchase?

Yes

No, already own.

Any comments on housing need.

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* 5. Are you currently working with a realtor?

Yes

Name and contact information:

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* 6. Are you currently working with a lender (if purchasing) or servicer (if needing help for foreclosure prevention)?

Yes

Name and contact information:

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* 7. Marital Status:

	Married	Divorced	Separated	Never Been Married	Widowed	Domestic Partner
Participant	Participant Married	Participant Divorced	Participant Separated	Participant Never Been Married	Participant Widowed	Participant Domestic Partner

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* 8. Marital Status:

	Married	Divorced	Separated	Never Been Married	Widowed	Domestic Partner
Co-Participant	Co-Participant Married	Co-Participant Divorced	Co-Participant Separated	Co-Participant Never Been Married	Co-Participant Widowed	Co-Participant Domestic Partner

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* 9. Do you need to schedule a one-on-one counseling session? Please Read This Carefully - NOTE: This is a requirement if you would like to be assess for down payment assistance funds, WeBuild's homes, need help in finding the right lending institution or need help to save a home.

The counseling will also assess your mortgage and homeownership-readiness and give you guidance on how to get to "Yes" from a lender/servicer.

Yes

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* 10. Number of people in your household:

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* 11. Date of Birth - Participant

Enter your birthdate:

Date

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* 12. Date of Birth - Co-participant

Enter your birthdate:

Date

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* 13. Which race/ethnicity best describes you? (Please choose only one.)

	American Indian or Alaskan Native	Asian/Pacific Islander	Black or African American	Hispanic	White/Caucasian	Choose Not to Respond
Participant	Participant American Indian or Alaskan Native	Participant Asian/Pacific Islander	Participant Black or African American	Participant Hispanic	Participant White/Caucasian	Participant Choose Not to Respond
Co-Participant	Co-Participant American Indian or Alaskan Native	Co-Participant Asian/Pacific Islander	Co-Participant Black or African American	Co-Participant Hispanic	Co-Participant White/Caucasian	Co-Participant Choose Not to Respond

Multiple ethnicity / Other (please specify)

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* 14. What is your citizenship status? (Please choose only one.)

	US Citizens	DACA	Permanent Resident Alien
Participant	Participant US Citizens	Participant DACA	Participant Permanent Resident Alien
Co-Participant	Co-Participant US Citizens	Co-Participant DACA	Co-Participant Permanent Resident Alien

Other (please specify)

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* 15. Rural Area Status:

	Household lives in a rural area	Household does not live in a rural area
Participant	Participant Household lives in a rural area	Participant Household does not live in a rural area
Co-Participant	Co-Participant Household lives in a rural area	Co-Participant Household does not live in a rural area

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* 16. Ethnicity Type:

	Hispanic/Latino	Not Hispanic/Latino	Choose Not to Answer
Participant	Participant Hispanic/Latino	Participant Not Hispanic/Latino	Participant Choose Not to Answer
Co-Participant	Co-Participant Hispanic/Latino	Co-Participant Not Hispanic/Latino	Co-Participant Choose Not to Answer

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* 17. Limited English Proficiency Status:

	Household is Limited English Proficiency	Household is not Limited English Proficiency
Participant	Participant Household is Limited English Proficiency	Participant Household is not Limited English Proficiency
Co-Participant	Co-Participant Household is Limited English Proficiency	Co-Participant Household is not Limited English Proficiency

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* 18. Preferred Language

	English	Spanish
Participant	Participant English	Participant Spanish
Co-Participant	Co-Participant English	Co-Participant Spanish

Other (please specify)

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* 19. Employment Information - Participant

Name of Employer:

Yearly Income:

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* 20. Employment Information - Co-Participant

Name of Employer:

Yearly Income:

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* 21. Do you have an emergency fund?

Yes

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* 22. Do you have a retirement account?

Yes

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* 23. I could handle a major unexpected expense.

Strongly agree

Agree

Neither agree nor disagree

Disagree

Strongly disagree

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* 24. Do you feel that you are secure in your financial future?

Strongly agree

Agree

Neither agree nor disagree

Disagree

Strongly disagree

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* 25. Because of my money situation, I feel like I will never have the things I want in life.

Strongly agree

Agree

Neither agree nor disagree

Disagree

Strongly disagree

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* 26. I can enjoy life because of the way I'm managing my money.

Strongly agree

Agree

Neither agree nor disagree

Disagree

Strongly disagree

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* 27. I am concerned that the money I have or will save won't last

Strongly agree

Agree

Neither agree nor disagree

Disagree

Strongly disagree

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* 28. I feel like I am just getting by financially - living paycheck to paycheck

Strongly agree

Agree

Neither agree nor disagree

Disagree

Strongly disagree

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* 29. Acknowledgement: I am aware that this is an introduction to increasing financial empowerment skills and pre-purchasing & foreclosure prevention education.

	Agree
Participant	Participant Agree	Participant
Co-Participant	Co-Participant Agree	Co-Participant

Other (please specify)