EMCRI Workforce Readiness Intake Form

Thank you for your interest in learning more about workforce readiness intake initiatives delivered by Help Keep Me Out The Streets Inc.

This short form helps us to collect high-level interest and readiness information from employees whose employer is exploring EMCRI participation.

First Name *

Last Name

Email *

Employment Status

General Question

Sales Inquiry

Support Request

Partnership / Collaboration

Other

Select all that apply

How long have you been with your current employer? *

Friend

Family Member

Employer

Case Manager

Community Organization

Other

Do you plan to stay with your current employer for the next 12 months? *

Yes

Unsure

Do you have at least 1 month of emergency savings? *

Yes

Working on it

In the past 6 months, have financial challenges impacted your attendance or focus at work? *

Yes

Occasionally

Are you currently working toward improving your financial stability? *

Yes

Not yet

Open to resources

Have you previously participated in employer-sponsored financial education? *

Yes

Which areas would be most helpful to strengthen? *

Budget planning

Savings strategy

Debt management education

Credit literacy education

Long-term financial planning

General financial organization

Are you open to structured financial readiness education through your employer? *

Yes

Maybe

What would you hope to gain from participating?

I understand this intake supports workforce financial readiness initiatives and does not guarantee any financial outcome or employment decision. I agree to receive program-related communication regarding workforce financial readiness resources.