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### 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 10BConsumer Background Consumer Biographical 10CConsumer Background Consumer Biographical 11 Consumer Background Consumer Biographical11BConsumer 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 22BConsumer Background Consumer Biographical 22DConsumer Background Consumer Biographical23 Consumer Background Consumer Biographical 24 Coaching History Consumer Biographical 24BCoaching 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 StatusEmployment 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 CollectionDropdown: 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 g X Allow analysis of program impacts on different demographic g X Allow analysis of program impacts on different demographic g X Allow analysis of program impacts on different demographic g 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 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. XCoaching: 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. XProvide 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