Lexington Office: 21 W. 2nd St. Lexington, NC 27292
Office Phone# (336) 236-1675
Email: Phyllis@homesolutionsdcnc.org
Financial Fitness Club Agreement
Client/Account Information
Thank you for your interest in the Financial Fitness Club hosted by Home Solutions of Davidson County, NC (HSDCNC). Please note: These classes are typically only given twice a year (usually every 6 months). Filling out the form below only reserves you a seat for the next available FFC and you will be contacted by a staff member to inform you when those dates may be. Seats are not guaranteed until official dates have been set and the $25 (non-refundable) enrollment fee is collected.
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Full Name
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First Name, Middle Initial, Last Name
Phone Number
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ex. (336) 123-4567
Format: (000) 000-0000.
Email
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example@example.com
Preferred Language
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English, Espanol, etc.,
Please answer the following questions, if unsure then please type 'help':
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By checking the box below you agree to participate in the "Financial Fitness Club" for five months once the final dates are set for the next round of sessions. You must also agree to commit to your short and long term goals while attending the financial education program provided by Home Solutions of Davidson County, NC (HSDCNC). You also acknowledge that you will have to set and stick to a disciplined budget and savings plan in order to reach your goals. Attendance to all 10 sessions of the Financial Fitness Classes are mandatory in order to complete the program requirements. Any missed classes must be made up through one-on-one counseling session(s) with a counselor. Upon completion, a financial incentive of 'up to' $300 will be made directly to the vendor that the counselor best sees fit according to your credit report and goals set during the initial intake and counseling session. The required $25.00 (non-refundable) enrollment fee is due the day client(s) get officially enrolled into the FFC program.
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Enter 3 Short term goals (ex. create budget, reduce debt, start emergency fund)
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Enter 3 Long term goals (ex. plan for retirement, payoff mortgage, etc.,)
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Action Plan: Create an action plan to help achieve your goals. Set SMART goals. S=specific, M=measurable, A=attainable R=relevant T=time-based
If you need help with this then we can assist you!
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If using a mobile device then please use your finger or stylus for your signature.
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Participant's Signature
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That's it for now! Just hit submit below if you are finished or save to continue later. Thank you for signing up for the Financial Fitness Club. Your information will be reviewed as soon as possible and you should receive a response within 3-5 business days. If you need further assistance then please call our office Monday-Friday between 9:00am-5:00pm at 336-236-1675.
Submit
Final FFC Match:
Final approved match of up to $300 by HSDCNC
Counselor signature:
HSDCNC Counselor Signature
Should be Empty: