Application for MCA Small Group Initiative We appreciate your interest in participating in the Maryland CASH Academy's Small Groups! Groups will offer members accountability, encouragement and support with specific financial goals. Additionally, they will work with a Maryland CASH Campaign educator(s) to learn the nuts and bolts related to their goal (spending plans, savings, or credit).Please complete this survey to help us identify how we can best meet your needs.Small groups will meet on a weekly basis for two months. If selected, you will be invited to an orientation with other group members. Question Title * Contact Information First and Last Name: Address: Address 2: City/Town: ZIP: Email Address: Phone Number: Question Title * Please rate each of the following financial goals. Most Important Somewhat Important Least Important Saving more money Saving more money Most Important Saving more money Somewhat Important Saving more money Least Important Improving my credit Improving my credit Most Important Improving my credit Somewhat Important Improving my credit Least Important Spending within my income Spending within my income Most Important Spending within my income Somewhat Important Spending within my income Least Important Question Title * What form(s) of communication are you most comfortable using? Email Group coaching with several other people (in-person) Group coaching with several other people (over the phone and internet) One-on-one coaching (in-person) One-on-one coaching (over the phone and internet) Telephone (talking) Telephone (text messaging) Question Title * How comfortable are you sharing the following information? Very uncomfortable Somewhat uncomfortable Somewhat comfortable Very comfortable N/A Credit history (ex. payment history) Credit history (ex. payment history) Very uncomfortable Credit history (ex. payment history) Somewhat uncomfortable Credit history (ex. payment history) Somewhat comfortable Credit history (ex. payment history) Very comfortable Credit history (ex. payment history) N/A Your past experiences with money Your past experiences with money Very uncomfortable Your past experiences with money Somewhat uncomfortable Your past experiences with money Somewhat comfortable Your past experiences with money Very comfortable Your past experiences with money N/A List of income and expenses List of income and expenses Very uncomfortable List of income and expenses Somewhat uncomfortable List of income and expenses Somewhat comfortable List of income and expenses Very comfortable List of income and expenses N/A Goals and aspirations Goals and aspirations Very uncomfortable Goals and aspirations Somewhat uncomfortable Goals and aspirations Somewhat comfortable Goals and aspirations Very comfortable Goals and aspirations N/A Credit account balances/limits Credit account balances/limits Very uncomfortable Credit account balances/limits Somewhat uncomfortable Credit account balances/limits Somewhat comfortable Credit account balances/limits Very comfortable Credit account balances/limits N/A Balance in deposit accounts (checking/savings) Balance in deposit accounts (checking/savings) Very uncomfortable Balance in deposit accounts (checking/savings) Somewhat uncomfortable Balance in deposit accounts (checking/savings) Somewhat comfortable Balance in deposit accounts (checking/savings) Very comfortable Balance in deposit accounts (checking/savings) N/A Values and attitudes about money Values and attitudes about money Very uncomfortable Values and attitudes about money Somewhat uncomfortable Values and attitudes about money Somewhat comfortable Values and attitudes about money Very comfortable Values and attitudes about money N/A Question Title * Why are you interested in participating in the Maryland CASH Academy small group? If selected to participate, what do you hope to achieve? Question Title * In what city do you prefer to meet? Question Title * What day(s) are you available to meet? 6:00AM-7:00AM 7:00AM-8:00AM 8:00AM-9:00AM 12:00PM-1:00PM 4:00PM-5:00PM 5:00PM-6:00PM 6:00PM-7:00PM 7:00PM-8:00PM Monday Monday 6:00AM-7:00AM Monday 7:00AM-8:00AM Monday 8:00AM-9:00AM Monday 12:00PM-1:00PM Monday 4:00PM-5:00PM Monday 5:00PM-6:00PM Monday 6:00PM-7:00PM Monday 7:00PM-8:00PM Tuesday Tuesday 6:00AM-7:00AM Tuesday 7:00AM-8:00AM Tuesday 8:00AM-9:00AM Tuesday 12:00PM-1:00PM Tuesday 4:00PM-5:00PM Tuesday 5:00PM-6:00PM Tuesday 6:00PM-7:00PM Tuesday 7:00PM-8:00PM Wednesday Wednesday 6:00AM-7:00AM Wednesday 7:00AM-8:00AM Wednesday 8:00AM-9:00AM Wednesday 12:00PM-1:00PM Wednesday 4:00PM-5:00PM Wednesday 5:00PM-6:00PM Wednesday 6:00PM-7:00PM Wednesday 7:00PM-8:00PM Thursday Thursday 6:00AM-7:00AM Thursday 7:00AM-8:00AM Thursday 8:00AM-9:00AM Thursday 12:00PM-1:00PM Thursday 4:00PM-5:00PM Thursday 5:00PM-6:00PM Thursday 6:00PM-7:00PM Thursday 7:00PM-8:00PM Friday Friday 6:00AM-7:00AM Friday 7:00AM-8:00AM Friday 8:00AM-9:00AM Friday 12:00PM-1:00PM Friday 4:00PM-5:00PM Friday 5:00PM-6:00PM Friday 6:00PM-7:00PM Friday 7:00PM-8:00PM Saturday Saturday 6:00AM-7:00AM Saturday 7:00AM-8:00AM Saturday 8:00AM-9:00AM Saturday 12:00PM-1:00PM Saturday 4:00PM-5:00PM Saturday 5:00PM-6:00PM Saturday 6:00PM-7:00PM Saturday 7:00PM-8:00PM Other (please specify) Question Title * How did you hear about the Small Group Initiative? Colleague/Friend/Relative Facebook Maryland CASH Academy E-News News article (online) News article (print) Radio Television Twitter Other (please specify) Done