Missoula Financial Fitness
Class Registration and Participant Information

“Financial Fitness classes are funded in part by the US Department of Housing and Urban Development, the Montana Board of Housing and NeighborWorks Montana.”

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/person registration fee to cover the cost of materials. You can pay online using the "Click here to pay online" link on the class schedule page or mail your registration fee to the attention of Holly Klier, after registering and prior to attending the class to reserve your place. Thank you.

Date:

Which Financial Fitness class date are you signing up for? Please choose from the drop-down list: -- October 19, 21 and 26th --

Please call me for Individual appointment, my phone number is

Child care needed during class? Yes No

Ages of children needing care: (example: 2 children - 4 & 6)

Client 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:

Race: -- American Indian/Alaskan and Black American Indian/Alaskan and Hispanic American Indian/Alaskan and White American Indian/Alaskan Native/Black and Hispanic Asian Asian and Hispanic Asian and White Black/Non Hispanic Black/African American and Hispanic Black/African American and White Chose not to respond Hispanic Hispanic Black Hispanic Black and White Native American/Alaskan Native Native American/Pacific Islander and Hispanic Native Hawaiian/Pacific Islander Unknown/Other (other Multi Race/Non Hispanic) White Non Hispanic

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.

Veteran: Yes No

Foreign Born: Yes No

Preferred Language -- English Chinese Cantonese Chinese Mandarin French Creole Hebrew Hindi Italian Korean Other Russian Spanish Urdu Yiddish

Head of Household (Do you file Head of Household on your taxes?): Yes No

Client 2 Profile

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

Veteran: Yes No

Foreign Born: Yes No

Preferred Language -- English Chinese Cantonese Chinese Mandarin French Creole Hebrew Hindi Italian Korean Other Russian Spanish Urdu Yiddish

Head of Household (Do you file Head of Household on your taxes?): Yes No

Household Information

Information for the following fields is REQUIRED for reporting purposes to the U.S. Department of Housing and Urban Development.

Marital Status: -- Common Law Marriage Divorced Live in partner Married Separated Single

Household Type: -- Single adult Married with children Married without children Female-headed single parent Male-headed single parent Two or more unrelated adults

Are you a first-time homebuyer? Yes No

Current Housing Status: -- Rent Own with a mortgage Own without a mortgage Homeless Own mobile home on permanent foundation Own mobile home not on permanent foundation

Disability - Client 1: -- Client 1 - Not Disabled Client1 - Disabled Disability - Client 2: -- Client 2 - Not Disabled Client 2 - Disabled

Number of people in household: