Financial Fitness
Class Registration and Participant Information

This registration is for "Financial Fitness" only.

Please complete one registration per household. This information assists us in understanding who our services reach, and is also reported to funding agencies including HUD and Montana Homeownership Network, a state housing network partnered with homeWORD. There is a $10 registration fee to cover the cost of materials. You can mail this in, Attention to Megan Powell, prior to attending the class or it will be collected on the first class day. Thank you.

Date:

Which class are you signing up for? Please choose from the drop-down list:

Please call me for Individual appointment, my phone number is

Child care needed during class? Yes  No   Number and Ages of children needing care:

Participant 1 Profile

First Name: Last Name:

Address:

City: State: Zip: County:

Daytime Phone: Evening Phone:

Email: (email optional, provide if you want occasional updates from homeWORD)

Birthdate:

Age:

Please choose BOTH a racial identity and an ethnic identity*. Thank you.
Racial Identity
 Single Race:

OR

Multi-Race:

Ethnic Identity
Hispanic (Cuban, Mexican, Puerto Rican, Other): Yes No

*These ethnic and racial categorizations have been developed by the U.S. Office of Management and Budget and must be used by this agency when reporting to the U.S. Department of Housing and Urban Development.

Foreign Born: Yes No

Gender:  

Participant 2 Profile

First Name: Last Name:

Address:

City: State: Zip: County:

Daytime Phone: Evening Phone:

Email: (email optional, provide if you want occasional updates from homeWORD)

Birthdate:

Age:

Please choose BOTH a racial identity and an ethnic identity*. Thank you.
Racial Identity
 Single Race:

OR

Multi-Race:

Ethnic Identity
Hispanic (Cuban, Mexican, Puerto Rican, Other): Yes No

*These ethnic and racial categorizations have been developed by the U.S. Office of Management and Budget and must be used by this agency when reporting to the U.S. Department of Housing and Urban Development.

Foreign Born: Yes No

Gender:  

Household Information

Household type:

Current Housing Status:

Education: Participant 1

Education: Participant 2

Does any member of your household have a disability?: Yes  No

Number of adults:   Number of Children: Ages of Children:

Number of People in Household:

Gross annual household income (before taxes for all household earners):

How did you find out about this class? Who referred you?

This is an electronically submitted form. By clicking "Submit," the form will go directly to our Class Registrar. Thank you.