💰 Financial Empowerment Registration

💰 Financial Empowerment Registration

Preference will be given to those that demonstrate commitment to complete the program until the end and would make the greatest net impact to their lives (based on what you write in the application).
Email
example@example.com
Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Sign up for SMS
Have you registered for a Success Accelerator workshop/program in the past?
Note: If you haven't completed a registration form before, please select "No". If you're registering for multiple, just select "No" for the first one.
Preferred Name
If it differs from your legal name
What pronouns do you use?
Example: she/her, he/him, they/them, etc.
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Referred by (please include the organization and name of the person)
Email of referral person
example@example.com
Which of the following do you identify with?

Other
What is your highest level of education?

Other
Are you committed to putting in the word to get a financial breakthrough?

1

2

3

4

5

1 is Not really, 5 is Absolutely
Have you ever taken any programs related to financial literacy?

Other
What do you want to get out of partaking this program?
Please declare the intentions for yourself
How would you rate your relationship with money?

1

2

3

4

5

1 is Poor, 5 is Excellent
How would you rate your financial habits?

1

2

3

4

5

1 is Poor, 5 is Excellent
How would you rate your overall financial knowledge?

1

2

3

4

5

1 is Poor, 5 is Excellent
Do you have debt? (We ask this to make the program more relevant)

Other
Do you have debt? (We ask this to make the program more relevant)

Other
Do you know how much money you have coming in or going out each month?

1

2

3

4

5

1 is No idea, 5 is Yes, with clarity
Do you have a financial plan?

1

2

3

4

5

1 is No idea, 5 is Yes, with clarity
What are your Financial Empowerment goals?
There are 2 panelist discussions during the program, and the specific topics will be selected based on participant interest. Please select the 2 topics you are most interested in learning about
Are you able to join the first session in-person? Date is still being finalized, and will be a Saturday in June.
Do you have any dietary restrictions?
Please share your dietary restrictions
Would you request for reimbursement of transportation expenses? (eg. public transit fare)
The reimbursement would be $6.70, roundtrip. If you require more, please explain the request.
Please note, we have a small budget for this, and you will not be reimbursed unless approved in writing by email.
Would you please share more context and let us know when you can confirm by?
Since you are not able to join in-person, please confirm your mailing address for us to send you the workbook.

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
By continuing with this application, you agree to the following terms and conditions:

If you indicated that you are referred by an organization or someone, we may share the attendance of your participation in our program(s) with the organization or person as indicated https://www.successaccelerator.ca/terms-and-conditions AND https://www.successaccelerator.ca/media-release
Please confirm
Signature
Is Client?
Should be Empty:

💰 Financial Empowerment Registration

By continuing with this application, you agree to the following terms and conditions: