Women's Money Matters
Getting to Know You Survey

Please select your language.

This 6 section enrollment survey enables us to learn more about you, your education, employment, current financial background, and confidence level about personal finance. The information helps our team match you with a great coach and effective curriculum to best support you and your goals. We understand this is very personal and encourage you to take your time answering each question.

This survey will take approximately 15 minutes to complete.

Program Selection

Please select a program format

Financial Futures Collective (Women seeking financial wellness - Ages 21+)

Life Launch (Girls and young women preparing to live independently - Ages 14-22)

REQUIRED

Primary Language

REQUIRED

Other Primary Language

REQUIRED

Do you speak an additional language?

YesNo REQUIRED

Other Secondary Language

REQUIRED

Ethnicity/Race (Check all that apply.)

Asian/Asian American/of Asian descentBlack/African American/of African descentHispanic/Latino/Latina/Latinx/of Latinx or Spanish-speaking descentMiddle Eastern/North African/of North African descentMulti-racial or multi-ethnic (2+ races/ethnicities)Native American/American Indian/Alaska Native/IndigenousOther - please specifyPacific Islander/Native HawaiianWhite/of European descent REQUIRED

Other - please specify

REQUIRED

Dependents
Enter the number of dependents you have for each age group. If you don't have dependent(s), leave 0 for all.

Infant - 5 years	6 - 13 years	14 - 18 years	18+ years
REQUIRED	REQUIRED	REQUIRED	REQUIRED

Education

Please share your current education status

If able to attend school, please share the level of education completed.

REQUIRED

Other Level of Education

Have you taken a financial education class in school?

Yes

No

Employment

Please select which best describes your current employment status.

Please select your current industry.
This question is meant to collect general industry data and not exact title or company information.

Other Industry

Job Title

What kind of work do you do?

Finances

My estimated monthly net income is .
(Net income is your take home pay after taxes.)

$

Net income is your take home pay after taxes.

In the past 3 months, I have saved .
(Enter "0" if not applicable.)

$

What is your most significant financial challenge?

Confidence

In the past month, how confident have you felt:

Financial Well-Being (Only answer if you are age 18 or older)

Please visit https://www.consumerfinance.gov/consumer-tools/financial-well-being/ on a new tab, and answer the requested questions. At the end of the page, click "Get my Score" and record the number generated below. We will ask you to complete this survey again at the end of the program to help us measure changes in our community’s financial well-being.

My financial well-being score is:
(Your score should be between 0 - 100.)

REQUIRED

Media Release Form (Only sign if you are age 18 or older)

We hope to celebrate the successes of our programs and participants with a wider audience, sharing photos and stories on social media and with our supporters. Please let us know if you approve us to use your media to spread the word about our programs, by choosing one of the options below:

I hereby acknowledge and agree that my image and/or voice may be used and/or reproduced in connection with my participation in the Women's Money Matters program. I acknowledge and agree that meetings held virtually may be recorded and still photographs of the virtual meetings may be taken. I grant Women's Money Matters and its business partners all rights to the recording, taping, reproduction, copyright, display, distribution, redistribution, and transmission of my image and/or voice, any chat/text responses, and answers to any polling questions and waive all claims, including but not limited to privacy and compensation claims, I may have against Women's Money Matters and its business partners in connection with such use. I further waive all claims against Women's Money Matters or its business partners that I, my agents, heirs, or assigns may possess, now or in the future, in connection with such use including restrictions on waivers of future claims.

I do not agree to allow Women's Money Matters to use my image and/or voice in any capacity in connection with my participation in a Women's Money Matters program(s) and/or events.

Credit Score Bucket Release Form (Only answer if you are age 18 or older)

Women’s Money Matters strives to provide impactful financial wellness programs to support women and girls as they work to meet their financial goals. One way we do this is by measuring program impact. It is helpful for us to understand participant credit scores and the impact the program has on them.

We respectfully ask your permission to collect your general credit score bucket (e.g., score of 500-550) and measure how it changes over time.

This data (general credit score bucket and your personal information) will be held securely by Women’s Money Matters, and will not be shared in any non-anonymous capacity outside of the organization. Additionally, the data collection will not impact your credit score. Let us know if you would be okay with us collecting your general credit score information for program impact measurement, program improvement, and future support and opportunities.

Release Form Choice

I hereby acknowledge and provide consent for Women’s Money Matters to access my credit files with the credit reporting agencies under the Fair Credit Reporting Act (FCRA) and to exchange the information about you to such national credit reporting agencies in order to to verify your identity using the information you provided (including but not limited to name, address, date of birth, email address, phone number) and receive a credit score bucket (not an exact credit score) for the purposes of program improvement, future support, and coaching opportunities for graduates.

I do not provide consent for Women’s Money Matters to access my credit files in any capacity.

Participant Agreement

May we share this survey with your coach?

Yes

No

As a participant, you receive one-on-one support from a volunteer coach. In addition to attending a series of workshops with your coach, you and your coach can have individual follow-up discussions - either in person or virtually. We request you contact your coach at least 24 hours in advance, if possible, if you cannot make a scheduled workshop or meeting.

Please sign below to indicate you understand and accept the responsibilities required of participants in this program.

Disclaimer: Coaches Are Not Financial Professionals

The information provided by our coaches is intended for general guidance and support purposes only. Our coaches are not licensed financial professionals, and they do not provide financial, investment, tax, or legal advice. The coaching services offered by our team are designed to assist you in setting and achieving your personal and financial goals. We do not make specific financial recommendations or endorse any particular financial strategies or products.

It is important to consult with a qualified financial advisor, accountant, or attorney before making any financial decisions, investments, or legal arrangements. Our coaches are not a substitute for seeking professional advice tailored to your unique circumstances. Any discussions or interactions with our coaches are for informational and motivational purposes. We do not guarantee specific financial outcomes, and the responsibility for your financial decisions remains with you.

While our coaches are committed to providing you with the support and encouragement you need to work towards your goals, it is crucial to exercise your own judgment and consult appropriate experts when necessary. Your financial well-being is a personal matter, and we encourage you to take all necessary precautions when making financial decisions.

Release Form Choice

I hereby acknowledge and understand that Women's Money Matter Coaches are not financial advisors.

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	Very Confident	Somewhat Confident	Not Confident	I don't know
Managing your money?
Planning for your financial future?

Women's Money MattersGetting to Know You Survey

Women's Money Matters
Getting to Know You Survey