Getting Ahead Application

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Please use this to apply for a Getting Ahead Workshop offered by The Frederick County Getting Ahead Coalition

Email *

First Name

Last Name *

At which location in Frederick County would you prefer to take Getting Ahead? (We cannot guarantee acceptance or a spot at a specific location) *

Emmitsburg/Thurmont/Catoctin Feeder Area

Downtown Frederick

Date of Birth *

YYYY

Phone Number *

Current Mailing Address (if you have one) *

Number of people in Household *

Number of Adults in Household *

Number of Children0 in Household *

First Child's First Name (type n/a if not applicable)na *

First Child's DOB (Skip if n/a)

YYYY

School - Grade (Skip in n/a)

Second Child's Name (Skip if n/a) *

Second Child's DOB (Skip if n/a)

YYYY

School - Grade (Skip if n/a)

Third Child's First Name (type n/a if not applicable) *

Third Child's DOB (Skip if n/a)

YYYY

School - Grade (Skip if n/a)

Household Greater Than 3 Children *

Yes

Monthly Income Sources (Check all that apply) *

Employment Income

Social Security Income

Child Support

Tdap

Other:

Required

Estimated Total Average Monthly Income *

Estimated Total Average Monthly Expense *

Regular Monthly Expense Items (Check all that apply) *

Utilities (electric, water, gas, cell phone etc.)

Rent

Transportation

Educational

Medical

Other:

Required

Current Total Savings *

Average Budgeted Monthly Saving Amount *

Do You own a vehicle? *

Yes

How did you hear about Getting Ahead?

Send me a copy of my responses.

Submit

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