• General Application

  • Format: (000) 000-0000.
  • Date of Birth*
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  • Emergency Assistance

    Answering the emergency assistance questions helps us determine your eligibility and assist you in the best way possible.
  • Are you interested in Emergency Assistance?*
  • Which Partner Do You Work With?*

  • Emergency Assistance Eligibility Notice

    Only members of one of the predefined organizations above are eligible for emergency assistance. 

  • Which Location Do You Work At?*
  • Have you applied for assistance before?*
  • What Steps Have You Already Taken?*
  • What Bill(s) Do You Need Assistance With?*
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  • Does anyone in your household receive any of these non-cash benefits?*

  • Demographics

    Answering the demographic questions helps us connect you with clients who may have requested someone with a similar background or lived experience.
  • Household Type*
  • Do you own or rent your housing?
  • What primary language is spoken at home?*
  • Gender
  • Cultural Heritage*
  • Are you a US Veteran?
  • Employment Status

  • Program Questions

    At Save First Financial Wellness, we ask about income, expenses, and non-cash benefits (such as SNAP or TANF) to better understand your financial situation and provide support that fits your needs. This information helps us determine eligibility for scholarships and our sliding fee scale, which is available to individuals and families earning up to 250% of the Federal Poverty Guidelines. All information is kept confidential and used only to ensure fair, equitable access to our services. Our goal is to meet you where you are and make financial education and coaching accessible to everyone.
  • Are you interested in Financial Education?*
  • Are you interested in Financial Coaching?*

  • The following questions are to understand your financial situation and help you find the best coach for your current financial position and goals.

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  • Do you have any preferences on the type of coach you are matched with that we can try to accommodate? (i.e. gender, age etc.)*
  • Please check all of the boxes for days that you are generally available to meet with a coach. (Please note that availability of staff coaches are limited to weekdays during working hours, volunteer coaches are subject to personal availability and may include weekends).*
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  • Are you interested in receiving coaching remotely or in person?*
  • Are you interested in applying for a Financial Coaching scholarship if you are deemed eligible?*
  • Are you interested in Resource Navigation?*
  • What resources are you interested in?*
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  • How did you hear about us?*
  • Corporate/Faith Partner Name*
  • Community Partner Name*

  • Please only click the Submit button below once, unless you are clicking it again after resolving a field error.

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