Registration Form
Money Smart for Families assists families in Polk, Hardee and Highlands County gain independence through financial literacy classes for adults and children, culminating in an emergency savings account.
Adult #1
First Name
Last Name
Gender
Male
Female
Age
Adult #2
First Name
Last Name
Gender
Male
Female
Age
Ethnicity
White
Black
Hispanic
Asian
Native American
Multi-Racial
Other
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
-
Area Code
Phone Number
Email
example@example.com
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Ethnicity
White
Black
Hispanic
Asian
Native American
Multi-Racial
Other
Children
Child 1
First Name
Last Name
Age
Gender
Boy
Girl
School
Child 2
First Name
Last Name
Age
Gender
Boy
Girl
School
Child 3
First Name
Last Name
Age
Gender
Boy
Girl
School
Child 4
First Name
Last Name
Age
Gender
Boy
Girl
School
Total Number of People in Household
Annual Household Income
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Do You Currently Have? (Please Check All That Apply)
Checking Account
Credit Card(s)
Own Home
Savings Account
Credit Card Debt
Rent Home/Apt
Family Written Budget
Family Written Goals
Emergency Savings
Student Loan
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Money Smart for Families
Family Participation Agreement
- The Mulberry Community Service Center / Personal Finance Center of Polk County will provide a series of four financial classes and credit restoration services, at no cost to the family.
- Classes will include a light meal/snack (if taken Live), incentives, and prizes.
- The Mulberry Community Service Center / Personal Finance Center of Polk County will provide a Savings Account Incentive up to $150 for each family/household that meets the below criteria.
To earn the $150 Savings Incentive Match, the ______________________ Family agrees to provide the following:
Type your Last Name
Check Each of the Following
Completed Registration Form
Attend, actively participate in, and complete homework for all four financial literacy classes. (The Financial Stability Coach can provide information how to make up a missed class.) If taking online classes instead of live classes, complete the six required modules and provide the certificates.
Completed Family Goal Sheet and Family Quick Start Budget
Create and submit screenshot of EveryDollar budget account profile
Proof of Income (last year's tax return or most recent pay stub)
Savings accounts statements showing the beginning balance as of the date of first class, and the account balance increased by at least $300 as a result of periodic deposits
If opting to tak advantage of the free credit restoration services, check the following:
Pull Credit Report/Score at end of program
Name
First Name
Last Name
Signature
Date
-
Month
-
Day
Year
Date
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Release Form for Adults
I, being of legal age, hereby grant United way of Central Florida (UWCF), it's assigns or successors, permission to use my story and/or likeness, in whatever they desire. Furthermore, I consent that such story and/or likeness, shall be the property of UWCF, and they shall have the right to duplicate, reproduce and make other uses of such story and/or likeness as may be necessary, free and clear of any claim whatever on my part.
Name
First Name
Last Name
Signature
Email
example@example.com
Date of Birth
-
Month
-
Day
Year
Date
Mulberry Community Service Center
211 NW First Avenue | Mulberry, FL 33860
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Which Class are you interested in taking?
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Would like a ZOOM class or LIVE Class?
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Submit
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