EmailMe Form - generation2080 - Quarter 2 Worksheet v2

Name *

First Last

Email *

Phone *

### - ### - ####

Who is your CRM case manager? *

Who is your Common Wealth Charlotte financial counselor?

What is your Skyla account number (number will be hidden)? *

What is your credit score from Credit Karma? *

Is the information in your credit report accurate? *

Yes

No

If information is not accurate, what needs to change? Describe in a few words in the box below.

Do you have any debt in collection? *

Yes

No

If yes, write it down here (none if none).

Do you have any debt shown as derogatory or written off? *

Yes

No

If so, write it down here (none if none).

Do you pay off your credit cards each month or do you leave balances? *

Pay off

Leave balance

If you leave balances, how much do you leave?

QUIZ QUESTION:
What 2 things impact your credit score more than anything else? *

What makes up your credit score?

ACTION steps:
What action steps did my case manager and I agree to? *

Next Steps:
When is the next time I meet with my case manager for generation2080 discussion? *

I know that I need to save every 2 weeks as part of the generation2080 program. I may be withdrawn from the generation2080 program if I go 3 months or longer without saving in my generation2080 account. *

I know that I have to complete the video, complete the worksheet and meet with my case manager to receive the generation2080 match. *