# Category Purpose

1 Consumer Background Consumer Biographical

2 Consumer Background Consumer Biographical

3 Consumer Background Consumer Biographical

4

Consumer Background Consumer Biographical

5 Consumer Background Consumer Biographical

6 Consumer Background Consumer Biographical

7 Consumer Background Consumer Biographical

7B Consumer Background Consumer Biographical

8

Consumer Background Consumer Biographical

9

Consumer Background Consumer Biographical

10

Consumer Background Consumer Biographical

10B

Consumer Background Consumer Biographical

10C

Consumer Background Consumer Biographical

11

Consumer Background Consumer Biographical
11B

Consumer Background Consumer Biographical

12

Consumer Background Consumer Biographical

13

Consumer Background Consumer Biographical

14

Consumer Background Consumer Biographical

15

Consumer Background Consumer Biographical

16

Consumer Background Consumer Biographical

17

Consumer Background Consumer Biographical

18

Consumer Background Consumer Biographical

19

Consumer Background Consumer Biographical

20

Consumer Background Consumer Biographical

21

Consumer Background Consumer Biographical

22 Consumer Background Consumer Biographical

22B Consumer Background Consumer Biographical

22D

Consumer Background Consumer Biographical
23 Consumer Background Consumer Biographical

24 Coaching History Consumer Biographical

24B Coaching History Consumer Biographical
Indicator

First Name

Last Name

Middle Initial

Date of Birth

Sex

Hispanic/Latino

Race

Race: other write-in text field for 

Marital status

Number of children and/or dependents

Educational Background

Educational Background Other Conditional 

Write-in

Educational Background Student Status

Employment Status

 
Employment Status/Reason Unable to Work

Average number of hours worked per week

Annual income (before tax)

Does the client receive gov't assistance?

Types of government assistance received

Does the client reside in assisted housing?

Housing Status

Have you ever been evicted from a residence 

you were the main title-holder for?

Have you ever had your home foreclosed upon 

that you were the main title-holder for?

Have you ever filed for bankruptcy?

When did you file for bankruptcy?

Are you a Veteran of the US Military?

Date of Seperation or Retirement

Do you have a Transition Plan?
Sources of Additional Support

How did you hear about coaching services?

How did you hear about coaching services?
Values

Write-in name

Write-in name

Write-in name

Date value MM-DD-YYYY

Dropdown: Male/Female

Dropdown: "Yes/No"

Dropdown: Black or African American, White, American Indian or Alaska Native, Asian, Native 

Free text conditional if race select to "other" write in free text entry field for Race: Other 

Dropdown: "Never married, Married, Separated, Divorced, Widowed"

Write-in number

Drop-down: less than HS diploma, HS diploma or equivalent (GED), Some post-sec, Vo-tech 

or technical training certification, Associates degree, bachelor's degree, Master's or higher, 

other: write in

Free text entry field (conditional, Educational Background select option "other"

Dropdown: Full-time Student, part-time-student, not a student

Dropdown: Self-employed, work full-time, work part-time, homemaker, student, 

unemployed and seeking work, unable to work, retired

Financial Coaching Data Collection
Dropdown: Disabled, full-time caregiver, student/enrolled in training program, other: write 

in 

Write-in number

Write-in, enter dollar amount

Dropdown "Yes"/"No"/"Don't know"

Dropdown: "SNAP/Food stamps", "Unemployment Assistance", "EITC", "WIC", "TANF", 

"SSI", "SSDI", "Don't know"

Dropdown "Yes"/"No"/"Don't know"

Dropdown: "Owned by you or someone in your household with a mortgage/home equity 

loan," "Owned by you or someone in your household free and clear," "Rented," or 

"Occupied without payment of rent"

Dropdown "Yes"/"No"/"Don't know"

Dropdown "Yes"/"No"/"Don't know"

Dropdown "Yes"/"No"/"Don't know"

Date value MM-YYYY

Dropdown "Yes"/"No"/"Don't know"

Date value MM-DD-YYYY

Dropdown: "Yes"/ "No"/ "Don’t Know"
Free text field

"site name" (from dynamic option tied to specific coach), "walk-in,", or "other organization"

Free text field conditional if prior selection is set to "other site name" 
Justification EVC's Vet's

Allow the coach to establish a relationship with the 

consumer receiving financial coaching. X

Allow the coach to establish a relationship with the 

consumer receiving financial coaching. X

Allow the coach to establish a relationship with the 

consumer receiving financial coaching. X

Coaching: Allow the coach to ascertain how many years 

remain in the consumer's working life to shed light on 

potential future income streams; Program Analysis: Allow 

analysis of program impacts on different age groups. X

Allow analysis of program impacts on different demographic gX

Allow analysis of program impacts on different demographic gX

Allow analysis of program impacts on different demographic gX

Allow analysis of program impacts on different demographic gX

Coaching: Provide coach with information required to 

establish a family budget and/or to understand the 

consumer's complete financial situation. Analysis: allow 

analysis of program impacts on different demographic 

groups. X

Coaching: Provide coach with information required to 

establish a family budget and/or to understand the 

consumer's complete financial situation. Analysis: allow 

analysis of program impacts on different demographic 

groups. X

Coaching: Provide coach with information required to 

understand the consumer's potential for increased 

employment income; Anlaysis: allow analysis of program 

impacts on different demographic groups. X

Coaching: Provide coach with information required to 

understand the consumer's potential for increased 

employment income; Anlaysis: allow analysis of program 

impacts on different demographic groups. X

Coaching: Provide coach with information required to 

understand the consumer's potential for increased 

employment income; Anlaysis: allow analysis of program 

impacts on different demographic groups. X

Coaching: Provide coach with information required to 

understand the consumer's current income; Anlaysis: allow 

analysis of program impacts on different demographic 

groups. X
Coaching: Provide coach with information required to 

understand the consumer's potential for increased 

employment income; Anlaysis: allow analysis of program 

impacts on different demographic groups. X

Coaching: Provide coach with information required to 

understand the consumer's potential for increased 

employment income; Anlaysis: allow analysis of program 

impacts on different demographic groups. X

Coaching: Provide coach with information required to 

understand the consumer's current income; Anlaysis: allow 

analysis of program impacts on different demographic 

groups. X

Coaching: Provide coach with information required to 

understand the consumer's potential for increased income; 

Anlaysis: allow analysis of program impacts on different 

demographic groups. X

Coaching: Provide coach with information required to 

understand the consumer's potential for increased income; 

Anlaysis: allow analysis of program impacts on different 

demographic groups. X

Coaching: Provide coach with information required to 

understand the consumer's potential for increased income; 

Anlaysis: allow analysis of program impacts on different 

demographic groups. X

Provide coach with an understanding the consumer's current 

financial situation including major current expenses. X

Provide coach with an understanding of the consumer's past 

financial hardships and demonstrated ability to handle 

finances well. X

Provide coach with an understanding of the consumer's past 

financial hardships and demonstrated ability to handle 

finances well. X

Provide coach with an understanding of the consumer's past 

financial hardships and demonstrated ability to handle 

finances well. X

Provide coach with an understanding of the consumer's past 

financial hardships and demonstrated ability to handle 

finances well. X

Determine whether the consumer falls into the targetted 

demographic group. X

Determine whether the consumer falls into the targetted 

demographic group. X

Provide coach with an understanding of interrelated services 

already provided by the Federal Government. X
Provide coach with information required to understand the 

consumer's current income X

Evaluate the effectiveness of our site location choices and 

manage resources appropriately X

Evaluate the effectiveness of our site location choices and 

manage resources appropriately X