Participant Information Form

Apply to empower yourself through financial education.

  • Westwater Financial would like to learn how we can best support your financial literacy needs. To assist us in this process, please complete this form.The information you provide will remain confidential. We will not release your individual information to any other party, individual, or government agency without your prior written consent and approval.
  • MM slash DD slash YYYY
  • Emergency Contact Information

  • Household Information

  • "Household" includes: 1) Your financial dependents – i.e., your dependent children, 2) anyone you depend on financially – i.e., your parent, or 3) anyone your are financially interdependent with – for example, your spouse, or partner. Your "household" may or may not be the same as the people you live with.
  • If on PC hold "Ctrl Key" to save more than one.
  • Gender, Ethnicity, and Race Information

  • The following information is requested by the federal government in order to monitor compliance with federal laws prohibiting discrimination against applicants or recipients on the basis of ethnicity, race and gender. You are not required to furnish this information, but are encouraged to do so. This information will not be used in evaluating your application or to discriminate against you in any way. However, if you choose not to furnish the information, Westwater Financial is required to note the ethnicity, race and gender of individual applicants on the basis of visual observation or surname.
  • If on a PC, hold the "Ctrl Key" to select more than one.
  • This field is for validation purposes and should be left unchanged.

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