💰 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 Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Sign up for SMS
By checking this box, you consent to receive SMS messages from Success Accelerator at the phone number provided. Message frequency may vary. Standard message and data rates may apply. Reply STOP to opt out at any time. Reply HELP for assistance. Your mobile information will not be sold or shared with third parties for promotional or marketing purposes.
Have you registered for a Success Accelerator workshop/program in the past?
*
Please Select
Yes
No
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
*
 /
Month
 /
Day
Year
Date
Address
*
Street Address
Street Address Line 2
City
State / 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?
*
Involved with the Justice System (means a history with the criminal justice system and/or agencies such as John Howard or Elizabeth Fry)
Experienced homelessness
Experienced mental illness (either self-identify or clinically diagnosed)
Experienced trauma
Gender-Based, Intimate Partner and Family Violence
Indigenous
In or are leaving the care of the Children's Aid Society
LGBTQIA2S+
Low Income OR on Social Assistance (Low income means an individual who ears less than $20,778 per year or $41,198 per year for a family of four, Social Assistance includes government income subsidy including EI, OW, ODSP, or Basic Needs Allowance)
Newcomer (means individuals who have resided in Canada for less than five years)
Person with a Disability (this includes any physical disability, mental impairment, developmental disability or learning disability)
Racialized (means groups of people who might experience unequal or different treatment on the basis of race, ethnicity, language, religion or culture)
Refugees
Single parent (yourself)
Substance abuse/addiction
Unemployed
None of the above
Other
What is your highest level of education?
*
Some High School
High School/GED
Some Post-Secondary
College
Bachelor's Degree
Graduate Degree
Other
Are you committed to putting in the word to get a financial breakthrough?
*
Not really
1
2
3
4
Absolutely
5
1 is Not really, 5 is Absolutely
Have you ever taken any programs related to financial literacy?
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Never
Yup, just one
Yup, several in fact
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?
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Poor
1
2
3
4
Excellent
5
1 is Poor, 5 is Excellent
How would you rate your financial habits?
*
Poor
1
2
3
4
Excellent
5
1 is Poor, 5 is Excellent
How would you rate your overall financial knowledge?
*
Poor
1
2
3
4
Excellent
5
1 is Poor, 5 is Excellent
Do you have debt? (We ask this to make the program more relevant)
*
I do not want to disclose
No debt
Auto loan
Credit card debt
Line of credit
Mortgage
Payday loans
Personal loans
Student debt
Other
Do you have debt? (We ask this to make the program more relevant)
*
None at all
Less than $5,000
$5,001 to $10,000
$10,001 to $25,000
$25,001 to $50,000
$50,001 to $100,000
More than $100,001
I do not want to disclose
Not sure
Other
Do you know how much money you have coming in or going out each month?
*
No idea
1
2
3
4
Yes, with clarity
5
1 is No idea, 5 is Yes, with clarity
Do you have a financial plan?
*
No idea
1
2
3
4
Yes, with clarity
5
1 is No idea, 5 is Yes, with clarity
What are your Financial Empowerment goals?
*
Expand Financial Knowledge
Gain Financial Stability
Grow Savings
Improve Spending Habits
Reduce Debt
Transform relationship with money
Other
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
*
Digital Money & Financial Technology: Stop losing money to hidden fees and missed opportunities - master the digital tools that can save you hundreds.
Psychology of Spending & Behavioral Finance: Break free from impulse buying and emotional spending that's sabotaging your financial goals.
Financial Goal Setting & Vision Creation: Turn your biggest financial dreams into reality with a step-by-step blueprint that actually works.
Building Multiple Income Streams: Discover realistic ways to boost your income - learn what actually works, what to avoid, and how to start smart without upfront costs.
Investing Fundamentals for Beginners: Build long-term wealth the proven way - simple strategies that grow your money steadily over time, not overnight.
Debt Payoff Strategies: Hear real stories from people who dug themselves out of serious debt and discover what actually worked for them - strategies that could work for you too.
Are you able to join in-person on Saturday September 6, 2025?
Yes, absolutely!
I'd like to, but need to confirm
No, I won't be able to
Do you have any dietary restrictions?
*
Yes
No
Please share your dietary restrictions
*
Would you request for reimbursement of transportation expenses? (eg. public transit fare)
*
No thanks, please use the funds towards others that need it.
Yes, it would really help me out.
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
City
State / 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
*
Yes, I have read and agree to the statement set out above and the Terms & Conditions.
Yes, I'd like to receive communication and be the first to know what's going on at Success Accelerator!
Signature
Is Client?
*
Yes
Submit
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