2013 Application for MCA Small Group Financial Coaching If you're looking for help and encouragement in succeeding with your financial goals- you're in the right place. Thanks for your interest in participating Maryland CASH Academy's Small Groups! We have two groups beginning in the first week of June, one in Baltimore City and one in Montgomery County. There ARE spaces left. Deadline to apply is June 3rd, 2013. Groups will offer members financial education, encouragement and support with specific financial goals. If selected, you will work with Maryland CASH Campaign coaches to boost your financial IQ goal, identify key steps, and complete important financial assignments.Participation is 100% free- we are a non-profit organization that has received funding from the Annie. E. Casey Foundation in order to offer this program. The application will take 7-10 minutes. Next step: A Maryland CASH staff member will call you to discuss your application. Thank you! Please note: If you are in the midst of a life trauma, emotional upheaval or instability that might require individual support beyond our scheduled meetings with teachers, the group format may not be a good match at this time. Question Title * Contact Information First and Last Name: Address: Address 2: City/Town: ZIP: Email Address: Phone Number: Question Title * Are you interested in participating in the Gaithersburg (Montgomery County) or Baltimore City group? Montgomery County- meets Thursdays 6:00 PM- 7:30 PM Baltimore City- meets Tuesdays 5:30 PM- 7:00 PM Question Title * Do you have financial goals? Please describe them. Question Title * Please rate the importance of the following to you. Most Important Somewhat Important 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 Paying off debt Paying off debt Most Important Paying off debt Somewhat Important Paying off debt Least Important Sticking to a budget Sticking to a budget Most Important Sticking to a budget Somewhat Important Sticking to a budget Least Important Saving more money Saving more money Most Important Saving more money Somewhat Important Saving more money Least Important Question Title * Would you be willing to discuss your finances, including income, expenses, and debts, with a group of your peers? Yes Maybe No It depends (please specify) Question Title * How comfortable are you sharing the following information? Very uncomfortable Somewhat uncomfortable Somewhat comfortable Very comfortable 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 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 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 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 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 Question Title * Please select the option that best reflects your income. I have a full-time job. I have a part-time job, or money from work on the side. I receive public benefits such as cash assistance, food stamps, or unemployment insurance. I am on a fixed income. I am fully financially supported by a family member. I work (part-time or full-time) and also receive some public benefits. Other (please specify) 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 * Have you ever worked with a financial coach before? If so, please tell us where. Done
