Money Coach Student Enrollment Form

Welcome to Money Coach!

Step one: Complete this form. This form enrolls you in the Money Coach program. We will ask for your contact information and other personal information (age, high school, gender, and race). We use this information to track who is in the program. We also use this information to keep in touch with you and send you information about the program. Let your teacher or the program manager know if you have any questions. Let them know if do not want to fill out the form.

Program Managers: Stephaine Crosley (stephaine@securefutures.org), Kiana Ayala (kiana@securefutures.org), Pa Vang (pa@securefutures.org).

Student Contact Information

First Name*

Middle Name or Initial

Last Name*

Suffix

(ex. Sr., Jr., II, III)

Preferred First Name

Enter the name you would like us to address you by, if different from your legal name.

Personal Email Address*

DO NOT enter your school email address here.

School Email Address

Cell Phone

Home Phone

What are your social media handles? (Facebook, Instagram, Snapchat, etc.)

We will only use this information to contact you if we can not get a hold of you by email or phone. We will not be viewing your social media profiles.

LinkedIn Profile

If you have a LinkedIn profile, please enter the URL here. This will help us to keep in touch!

Home Address*

Address Line 1

Address Line 2

City

State

ZIP Code

Student Personal Information

What high school do you attend?*

What grade in school are you?*

Which organization or school is providing Money Coach for you?*

For most students this will be your high school, but for some it will be a community group like Boys & Girls Club or PEARLS for Teen Girls.

What is your date of birth?*

What is your gender?*

What are your pronouns?

https://uwm.edu/lgbtrc/support/gender-pronouns/#:~:text=What%20is%20a%20pronoun%3F,person%20you%20are%20referring%20to.

My gender is:

What is your race or ethnicity?*

Choose all that apply. To select more than one option, hold down the Crtl key and click the options.

Are you Hispanic or Latino?*

My race or ethnicity is:

Parent Guardian Information

Primary Parent/Guardian's Name*

First Name

Last Name

Relationship to student*

Primary Parent/Guardian's Email

Primary Parent/Guardian's Phone*

Secondary Parent/Guardian's Name

First Name

Last Name

Relationship to student

Secondary Parent/Guardian's Email

Secondary Parent/Guardian's Phone

Today's Date

Money Coach Student Participation Agreement

This is an agreement between you and SecureFutures’ Money Coach Program. The purpose of this document is to clarify the expectations for participation in the Money Coach Program, where participants will:

become better prepared to manage their finances independently after high school graduation,
build a mentor/mentee relationship with a volunteer Coach,
have an opportunity to earn college or career scholarship money, and
build self-confidence and life skills.

Money Coach participants specifically agree to the following program requirements and will hold themselves accountable for each requirement in order to be awarded all or part of the scholarship award:

Complete and return all forms and surveys by the stated deadlines.
Open a savings account in your name within one month of the start of the program, if you don’t already have one.
Successfully complete the Financial Goal Checklist.
- Create a savings goal and plan to accumulate funds to cover an expense related to a college or career.
- Work with a coach to discuss an important personal goal related to a college or career plan and develop a plan to achieve it.
- Track expenses, and create and follow a monthly budget.
- Responsibly manage a savings account.
Actively participate in group financial education lessons about budgeting, saving, credit, post-high school choices, and other relevant topics.
Work toward building a meaningful mentoring relationship with the One-on-One Coach.

The Money Coach Scholarship money is awarded based on the following criteria:

Attendance: Students will be paid $20 per session that they attend (maximum of $120). Students will work to maintain perfect attendance, will be on time and stay for the entire session, and will actively participate. Students must communicate all absences with the Site Partner and their One-on-One Coach before the missed session.
One-on-one: Students will be paid $20 per check-in (maximum of $100). Students must also schedule and attend a one-on-one check-in with their coach every other week to qualify for the payment. If a student is unable to make a check-in, they must contact their One-on-One Coach to reschedule.
Benchmarks: Students will be paid per benchmark met (maximum of $130). Benchmarks must be completed and submitted by the due date in order to receive credit.

Absences and missed assignments: Students will be allowed only two missed sessions, assignments, or check-ins. At the third miss, the student may be removed from the program. Late assignments and check-ins may be accepted at the discretion of the Program Manager, but may not count toward the scholarship.

*SecureFutures makes all final decisions regarding the amount of scholarship money awarded to each participant.

I agree to being committed to my role as a Money Coach participant and fully understand the obligations required of me to fulfill my role.*

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Use your mouse or finger to draw your signature above

Money Coach Pre-Survey

This survey will help SecureFutures improve the Money Coach program and measure our impact. We will use the results from the survey to see if the information you learn in the program causes you to change how you manage money. We will ask you to fill out the survey at the beginning and end of the program. This is not a test and you are not being graded. There are no right or wrong answers. If you do not want to complete the survey, that is okay. You will not be in trouble and no one will be upset with you. Let your teacher or the program manager know if you have any questions.

Program Managers: Stephaine Crosley (stephaine@securefutures.org), Kiana Ayala (kiana@securefutures.org), Pa Vang (pa@securefutures.org).

Employment

Do you currently have a job?*

Yes, I work part time. Yes, I work full time. No, I do not have a job.

Banking

Did you have a checking or savings account at a bank or credit union BEFORE joining the Money Coach Program?*

Yes No

Did you use online banking BEFORE joining the Money Coach Program? Online banking refers to a method of banking in which transactions are conducted electronically via a computer.*

Yes No

Did you use mobile banking BEFORE joining the Money Coach Program? Mobile banking refers to the use of a smartphone or other cellular device to perform online banking tasks while away from your computer.*

Yes No

Did you have a debit card BEFORE joining the Money Coach Program?*

Yes No

Credit Cards

Do you have access to credit card? If you are an authorized user on someone else's account or you have an account under your own name, select "yes." An authorized user gets their own card with their name on it, but the account is shared with one or more other people.*

Yes No

How do you manage your credit card payments?*

I pay the minimum balance each month. I pay more than the minimum balance each month, but I do not pay the entire balance. I pay the entire balance each month. I am not responsible for the card payments.

Expense Tracking

BEFORE you joined the Money Coach program, did you track your expenses on a weekly or monthly basis? Tracking expenses involves keeping a written record or using an app or spreadsheet to track everything you spend money on.*

Yes No

How did you track your expenses BEFORE you joined the Money Coach Program?*

Budgeting

BEFORE you joined the Money Coach program, did you have a written budget? A budget is a record of your money and how you plan to spend and save it each month.*

Yes No

Check Cashing Stores

In the last 3 months, have you cashed a check at a check cashing store, corner store, gas station, Walmart, Walgreens, or anywhere else that is NOT a bank or credit union?*

Yes No

In the last 3 months, how often have you cashed a check at one of these locations?*

1-3 times 4-8 times 9 or more times

Saving

Do you save money regularly?*

Yes, I save money regularly. No, I only save money sometimes. No, I do not save any money.

Financial Attitudes

For the following statements, please respond using the scale: 5=Strongly Agree, 4=Agree, 3=Neither agree nor disagree, 2=Disagree, 1=Strongly disagree.*

For the following statements, please respond using the scale: 5=Strongly Agree, 4=Agree, 3=Neither agree nor disagree, 2=Disagree, 1=Strongly disagree.
	5	4	3	2	1
I am good at saving money regularly.	For the following statements, please respond using the scale: 5=Strongly Agree, 4=Agree, 3=Neither agree nor disagree, 2=Disagree, 1=Strongly disagree.: I am good at saving money regularly. (5)	I am good at saving money regularly. (4)	I am good at saving money regularly. (3)	I am good at saving money regularly. (2)	I am good at saving money regularly. (1)
I am good at identifying reasonable saving goals.	I am good at identifying reasonable saving goals. (5)	I am good at identifying reasonable saving goals. (4)	I am good at identifying reasonable saving goals. (3)	I am good at identifying reasonable saving goals. (2)	I am good at identifying reasonable saving goals. (1)
I am good at managing my banking needs.	I am good at managing my banking needs. (5)	I am good at managing my banking needs. (4)	I am good at managing my banking needs. (3)	I am good at managing my banking needs. (2)	I am good at managing my banking needs. (1)
I am good at managing my spending.	I am good at managing my spending. (5)	I am good at managing my spending. (4)	I am good at managing my spending. (3)	I am good at managing my spending. (2)	I am good at managing my spending. (1)
I am prepared to manage my credit (loans, credit cards, credit score).	I am prepared to manage my credit (loans, credit cards, credit score). (5)	I am prepared to manage my credit (loans, credit cards, credit score). (4)	I am prepared to manage my credit (loans, credit cards, credit score). (3)	I am prepared to manage my credit (loans, credit cards, credit score). (2)	I am prepared to manage my credit (loans, credit cards, credit score). (1)
I am good at setting goals for my future.	I am good at setting goals for my future. (5)	I am good at setting goals for my future. (4)	I am good at setting goals for my future. (3)	I am good at setting goals for my future. (2)	I am good at setting goals for my future. (1)
I believe that I can achieve the goals I set for myself.	I believe that I can achieve the goals I set for myself. (5)	I believe that I can achieve the goals I set for myself. (4)	I believe that I can achieve the goals I set for myself. (3)	I believe that I can achieve the goals I set for myself. (2)	I believe that I can achieve the goals I set for myself. (1)

Save and Resume Later

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