Financial Education Intake Form

  • Please fill this form out completely to the best of your ability. Completing this form is a requirement to receive a certificate of attendance. This online form will be used instead of having you fill out a paper intake form. To attend the online workshop, you will receive a link directly from Zoom. If you have any questions or require assistance, please call Art Taggart at 716-884-7791 Ext. 123

  • Household Member (Name)Type of Income (Job, Food Stamps, SSI, Etc.)Gross Monthly Income (Before Taxes) 
  • DEMOGRAPHIC INFORMATION: Demographic information is used solely for statistical reporting requirements

  • This field is for validation purposes and should be left unchanged.