Financial Opportunity Contact and Intake Form

Financial Opportunity Contact and Intake Form

This form is for Cambridge residents seeking financial coaching. Please DO NOT complete this form if you are seeking tax help.

First name:

Last name:

Email address:

Phone Number

Birth date:

Gender identity:

Race (please check all that apply)

African American/BlackAsianHispanic/LatinxWhiteNative American/AlaskanNative Hawaiian or Pacific IslanderOther

Ethnicity:

City:

Zipcode:

Just-A-Start resident?:

YesNo

How did you hear about us? (Select all that apply):

Boston Career LinkPast program studentSchool or Other program staffTraining or Job FairCambridge Employment ProgramCambridge Housing Authority FlyerCambridge Learning CenterCambridge Multi-Service Center (MSC)CRLS Youth Employment CenterCurrent program studentEmailSocial mediaWord of mouthFriend or RelativeBlue Bike AdJAS Housing FlyerJAS PresentationJAS WebsiteOther FlyerHomeowner's Rehab IncOther

If Other, please specify:

Contact Information