Economic Wellness Services Interest Form

Economic Wellness Services Interest Form
Hello!

Thanks for your interest in LifeWise StL Economic Wellness Services.

Please fill out this form and one of our staff will contact you in 5-7 business days to speak further.
Full Name *

First Name Last Name
Below is a list of services we provide, please check which you are interested in: *

One-on-one Financial Coaching Savings Budgeting Credit Financial Education Classes Debt Management Credit Building Product Matched Savings Account Referral- In the comments please note what kind of referral you're seeking.
To help us determine what program would be best for you, please list your preferences from your first choice to your third choice (program requirements may vary):
- Emergency Matched Savings
- Individual Development Account (IDA)
- Debt Reduction Matched Savings
- Savings for Independence
- Youth Matched Savings
- ASSET
- Senior Resiliency Fund
- Lending Circles/Tandas
- Microloans
- Child Savings Account
- Financial Support Group
- Other (please list/describe in comments)
Which service is your first choice?
Which service is your second choice?
Which service is your third choice?
How did you hear about our program? *
Phone Number *

Area Code Phone Number
Do you prefer a call or text? *

Please call me Please text me Either one, doesn't matter
Best time to call/text you (check all that apply): *

9am-12pm 1pm-3pm
Best day(s) to call you (check all that apply): *

Monday Tuesday Wednesday Thursday Friday
Have you ever participated in a financial education course or program?

Yes No
Please describe the program.
Did you complete the program?

Yes No
Do you prefer to meet in person or virtually?

In person Virtually No preference
Additional information
Please provide any additional details you'd like us to know prior to calling you.
Should be Empty:

Economic Wellness Services Interest Form

Additional information