Bank On HR Signup Form (September 2019 Classes)
1.
Please enter the information indicated below.

By entering my personal information, I consent to receive email communications from the survey author's organization based on the information collected.

First Name:
Last Name:
Work Phone:
Home Phone:
Email Address:
emailaddress@xyz.com
Address 1:
Address 2:
City:
State/Province
(US/Canada):
Postal Code:

2.

Gender:

Male
Female
3.

Highest Education:

Pursuing GED
Pursuing Certificate
High School/GED
Completed Certificate Program
Some College
College Graduate
Masters Level or Higher
4.

Income: (choose one)

Regular Income (Disability, SSI, Social Security, etc)
Unemployed
Employed Part Time
Employed Full Time
  • Comment:

  • 500 characters left.
5.

Do you have a bank or credit union account?

Yes
No
6.
Alternative Financial Products Used in the past 12 months:
Non-bank check cashing
Non-bank money orders
Payday or title lending
Pawn shops
Rent to own
Rapid refund tax products
None of the above
7.

How did you hear of Bank On Hampton Roads?

E-mail
Web Search
Family/Friend
Flyer
Called Financial Empowerment
Financial Institution
Referral
Other
  • Comment:

  • 500 characters left.
8.

Preferred Class (see website for details):

Ches: Major Hilliard Library
Norf: Mt. Gilead Missionary Church
Norf: Food Bank
VB: Enoch Baptist Church
VB: TCC/Virginia Beach Joint-Use Librar
N/A
N/A
N/A
N/A
N/A
N/A
N/A