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 NameLast Name
Pronouns
What is your preferred language?*

EnglishSpanishOther
Phone Number*

Area CodePhone Number
Email (please put an email that you use regularly)*
example@example.com
Do you prefer a call or text?*

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

9am-12pm1pm-3pmOther
Best day(s) to call you (check all that apply):*

MondayTuesdayWednesdayThursdayFriday
Are you interested in any match saving program?

Saving for Independence (first year college students, victims of domestic violence)Debt Reduction (Collections, charge-off accounts, medical debt, predatory loans, etc)Emergency Match Savings / ASSET (create a $400 emergency funds)IDA (First time home buyer, buy a car, repair home, education, medical)
Additionally, we offer a variety of other programs and services. If you're interested in any of them, feel free to click for more information.Please note: All match savings programs require classes and coaching sessions.*

One-on-One coachingFInancial EducationLending CirclesOther
Below is a list of services we provide, please check which you are interested in:*

One-on-one Financial CoachingSavingsBudgetingCreditFinancial Education ClassesDebt ManagementCredit Building ProductMatched Savings AccountReferral- In the comments please note what kind of referral you're seeking.Other
I'm only interested in participating in the lending circle (if yes selected, you will be redirected to sign up for the waitlist upon submitting this form)

YesNoI'm interested in the lending circles, but also want to join other programs
To help us determine which services would be best for you, please let us know what you are looking for or what you need.
How did you hear about our program?*
Have you ever participated in a financial education course or program?

YesNo
Please describe the program.
Did you complete the program?

YesNo
Additional information

Please fill out this brief questionnaire to help us determine the best program options for you
Are you employed?/ Do you have an income?

Yes, I am employed full-timeYes, I am employed part-timeNoOther
Do you have children under the age of 18?*

YesNo
What is your annual household income?
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