Citizens Money Essentials - Financial Literacy Workshop
Location: 600 S. 17th St. Newark, NJ (Essex County West Side Park) Time: 4-5 p.m. All information collected is confidential and used only to understand the population being served and aid in providing services.
Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
E-mail
*
example@example.com
Are you a U.S. Military Veteran
*
No
Yes, I'm Active Military
Yes, I'm Retired
Other
Disclaimer: I understand this event is hosted in collaboration with an outside organization. United Community Corporation (UCC) is only providing support in promoting and sharing registration details. All financial advice and/or information is managed solely by the outside organization. UCC does not collect, store, or have access to any personal financial information provided during this event and cannot be held responsible for any financial decisions made by the individual as a result of this event. For questions or concerns regarding registration, please contact the event organizer directly.
*
Yes
I understand United Community Corporation (UCC) may use photos or videos taken of me during this event for its promotion and marketing materials. If, for any reason, I do not want to be included in UCC's marketing or promotion materials, I will take on the responsibility of notifying UCC.
*
Yes
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Household Information
This Information provided through this form is used to assist UCC in expanding the services we provide by identifying the demographics of the clients we serve.
Household Income
*
Please Select
No Income to $12,000
$26,000 to $40,000
Over $40,000
# of Children (Ages 0 - 18)
*
Please Select
None
1
2
3
4
5
6
7
8
9
10
# of Adults (Ages 18 - 62)
*
Please Select
None
1
2
3
4
5
# of Seniors (Over age 62)
*
Please Select
None
1
2
3
4
City of Residence
*
East Orange
Irvington
Newark
Other
Race/Ethnicity
*
African American
Hispanic / Latino
Caucasian
Asian
Prefer Not To Say
Other
Gender
*
Male
Female
Other
Signature
*
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