EmailMe Form - Generation2080 Application

Name *

First Last

Are you Latino/Hispanic?/ Eres Latino/Hispano?

Email *

Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Phone *

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

What is your age group? *

Who is your case manager at CRM? *

Are you currently employed? *

If you are employed, where do you work? *

Do you currently have a bank checking account? *

What's the name of your bank? *

What is your #1 financial goal? (describe below) *

Saving Question *

Can you plan to save $20 per pay period into a dedicated savings account and leave it there to grow?