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Overview
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Interest Form
Frequently Asked
GAIN Interest Form
Complete this form after attending the GAIN Orientation.
GAIN Interest Form
For clients interested in participating in the GAIN program.
Step
1
of
6
16%
Basic Information
Head of Household Name
First
Last
Email
Phone
Last 4 digits of your SSN
What goals are personally motivated to work on? (Select all that apply)
Educational goals
Obtaining employment or new employment
Better budgeting
Improving your credit score
Increased savings
Working toward homeownership
Education
What is your highest level of education?
Some high school
High school graduate
Some college, no degree
Trade/Technical/Vocational training
Associate's degree
Bachelor's degree
Master's degree
Doctorate
What field is your degree in?
What field is your trade/technical/vocational training in?
Are you currently enrolled in an educational program?
Yes, an Associate's degree program
Yes, a Bachelor's degree program
Yes, a Master's degree program
Yes, a Doctoral program
Yes, a trade/technical/vocational training program
No
Employment
What is your current level of employment?
Employed, full-time
Employed, part-time
Employed temporarily
Unemployed
How long have you been full-time in your current position?
Financial Well-Being
How much money do you have in savings?
What is your annual household income?
What is your credit score?
Support Needs
What obstacles prevent your from advancing your career, education, or financial health?
Do you have a disability that will require accommodation or additional support to complete program goals?
Yes
No
What is your current transportation status
I have a license and a vehicle
I have a license but not a vehicle
I do not have a license
Household Composition
How many adults live in your household?
How many children live in your household?
If there are children in the household, how many of the children are currently enrolled in school?
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