MDHS FFFN 06.22.26 Tupelo

Grant Reporting Information

Please complete a separate registration form for each participant. Each participant must have their own completed form on file in order to participate in the program.
The financial literacy portion of the program you and your child are attending is funded by the MS Department of Human Services (MDHS) TANF program via the MS Council on Economic Education (MCEE). While we are striving to serve participants with this funding that are SNAP eligible, the fact that you or your child does not receive SNAP benefits does not preclude your family from being part of the program we are offering.

All MCEE programs are related to economic and personal finance education. MCEE is required to report the following information about each participant we serve to support the funding we receive for this program. We will not share the information with anyone other than MDHS. MDHS will use the data to make sure we are not charging them to provide services to a participant that is receiving economic and personal finance education from another organization also supported by MDHS. The data you provide is encrypted during the delivery of the data to MCEE and keeps the data private.

If you have any questions, you can email MCEE at julie@mscee.org or call us at 657-659-7639. We look forward to serving each participant with age appropriate economic and financial literacy which will help them live a more successful life. You can learn more about MCEE at www.mscee.org.
At least one adult must participate with their child for the whole program.
A post program evaluation must be completed by the child and by the adult participating with the child. These evaluations will be available immediately after the program ends.
I give permission for any photos taken at the event to be used to promote the success of the program and for use in the annual report to the funding organization.
Last Four of Social Security Number
Valid digits are required to participate
Name

First NameLast Name
Date of Birth

MonthDayYear
Is participant a SNAP recipient?
County of Residence
Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Phone Number
If under 18, please provide a parent or guardian number.Format: (000) 000-0000.
Email Address
If under 18, please provide a parent or guardian email.
Employment Status
Highest School Grade Completed
Provide last complete year of school.
Age
Race
Sex
Ethnicity
Should be Empty:

Grant Reporting Information