HER Financial Recovery Project

HER Financial Recovery Project

Phase 1 Cohort Intake Application HOUSTON, TX-2025
This application is for consideration into the HER Financial Recovery Project six-month financial stabilization cohort. Completion of this form does not guarantee acceptance. Selected applicants will be contacted for a confirmation interview.
Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
AGE RANGE
Preferred Contact Method
Employment Status
Monthly Income
Do you have a bank account?
Have you reviewed your credit in the last 12 months?
Do you currently have a written monthly budget?
Do you know your tax situation?
Financial Confidence Scale
Do you have transportation barriers?
Do you have reliable internet access?
Referral Source

Other
Pathway Interest
Why are you interested in joining HER?
HER Financial Recovery Project is a structured six-month cohort meeting twice weekly. Participants are expected to attend consistently and complete assignments.
Are you fully committed to completing this program?
Are you able to commit to twice weekly participation?
Are you willing to complete assignments between sessions?
Primary Attendance Preference
Are you able to attend structured sessions for the full 6-month duration?
I understand that participation in the HER Financial Recovery Project requires active engagement, attendance, and adherence to program policies.

I acknowledge that:
- Incentives (gas cards, grocery cards, transportation support, etc.) are earned through participation and are not guaranteed.
- Incentives may be reduced or removed if I do not follow program expectations.
- A minimum of 70% completion is required to complete the program.
- Graduation rewards (including laptops) are only available to participants who meet 90%–100% completion requirements and remain in good standing.
I agree to actively participate, communicate with staff, and commit to my personal and financial growth.
I agree to the HER Financial Recovery Project policies
Signature
Date

MonthDayYear
Date
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HER Financial Recovery Project

This application is for consideration into the HER Financial Recovery Project six-month financial stabilization cohort. Completion of this form does not guarantee acceptance. Selected applicants will be contacted for a confirmation interview.