Clone of REELMOTION! Talent Network — Official Submission Intake

1

Welcome to the F.L.I.G.H.T. Program Application Form. Please complete all sections below to apply for our 6-week financial literacy program. This program is designed to help you achieve your financial goals through education and support. Be sure to provide accurate information, as this will help us better understand your needs and goals. Once you've completed the form, click 'Submit' to finalize your application.

2

Is this application for an individual in custody?* This field is required.

Yes

No

3

Full name of individual in custody?* This field is required.

First Name

Last Name

4

ID/Prison Number* This field is required.

5

Facility* This field is required.

6

What is your full name?* This field is required.

First Name

Last Name

7

Relationship to the Individual* This field is required.

Family

Friend

Associate

Other

8

What is your date of birth?* This field is required.

Date

9

What is your phone number?* This field is required.

Please enter a valid phone number.

10

What is your email address?* This field is required.

example@example.com

11

What are your financial goals?* This field is required.

12

How will you get to class?* This field is required.

Driving

Public Transportion

Other

13

Do you have prior financial literacy experience?* This field is required.

Yes

No