1x1 Financial Coaching Application
Financial Coaching is free and confidential. It is brought to you by Arlington and Alexandria's Virginia Cooperative Extension (VCE) Master Financial Education Volunteers. Coaching sessions are based on one's needs; coaches help with budgets, debt, answer financial questions, and provide helpful resources.

For more information, please visit https://arlington.ext.vt.edu/ If you have any questions, please contact Aisha Salazar, VCE Family & Consumer Sciences Agent, at asalazar@vt.edu
Email address *
Date *
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Phone number
First Name *
Last Name *
Goals you want to focus on (debt, retirement, budget, etc.). Try to be specific. You can select more than one goal. *
Required
Where do you live *
Family Situation (Married, Single, Children, etc, Other dependents) *
Monthly income for client and any spouse *
Housing situation (Rent, Own/Mortgage) *
Debt/Credit (Types, Amounts Owed, Interest Rates, Monthly Payment Amounts (Late/On Time), Credit problems?). Answer to the best of your knowledge. *
Gender *
Head of Household? *
Income Level *
Race & Ethnicity *
Required
Please add any other information you would like to provide.
Financial Coaching Agreement. Please read and sign. I understand that all my financial information will be confidential. My coach is my financial educator and cannot give me legal or financial advice, but can present me with resources, strategies and encouragement during coaching sessions. I understand that my coach will not make decisions for me or make contact with creditors or others on my behalf. Making decisions and taking action will be my sole responsibility. I understand that as a participant to this pilot program I will not receive legal advice or professional financial services. My coach will be there to support and encourage me during the term of the program. Ultimately, I am responsible for my actions. Neither Virginia Cooperative Extension (VCE) or Financial Coach will be held liable for any financial decisions I make as a result of this program. Please sign your name below. *
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