CFWM participant record

Your participation helps show community impact.

This secure form records program participation and de-identified outcomes so CFWM can responsibly pursue funding for future education, entrepreneurship, and homeownership programs.

Why we ask about income and household information

Many funders ask CFWM to report de-identified participant totals and income-band eligibility. Please answer based on your best understanding. Your self-attestation is not grant eligibility verification; each funder's requirements must be confirmed separately.

Participant details

Participant name *Email address *Phone number *Program, class, or cohort *Enrollment or attendance date *Participant category *

Location and household

County *ZIP code *City *State *Household size *Annual household income range *Select a range only. CFWM does not request an exact income on this form.

Grant reporting attestation

Do you self-attest that your household meets low-to-moderate-income guidelines for the programs you are seeking? *

This is self-attestation only. CFWM or a funder may need additional verification under a specific grant's rules.

YesNoPrefer not to say

I consent to CFWM using my information in de-identified, aggregate grant reports. My name, contact information, and exact responses will not be shown in public grant reporting. *

Submit a new form to correct information; prior submissions remain preserved.