Application Forms

DRAFT FOR INTERNAL REVIEW ONLY | cfpb_financial_coaching_initiative_form_r2-1

APPLICATION FOR PARTICIPATION IN THE

 CFPB Financial Coaching Initiative

OMB No. 3170-XXXX
Expiration Date: MM/DD/YYYY

The Consumer Financial Protection Bureau (CFPB)’s Financial Coaching Initiative
provides financial coaching services at critical points in consumers’ lives through
existing points of direct service. Through this program, 60 professional financial
coaches have been placed into community organizations – “host sites”— currently
serving consumers through various means, such as job training, social services,
legal aid, housing support, or other services.
The program is currently seeking an organization interested in and capable of
hosting a financial coach in [Name of specific communities]. The ideal organization
currently provides services to low-income and economically vulnerable clients and
would benefit from financial coaching as a complementary service to its clients.
This is not an opportunity for a grant, contract, sub-contract, or funding. This is
an opportunity to have a full-time, fully funded, certified and trained, professional
financial coach integrated into your organization in order to provide financial
coaching to your clients and/or to the clients of the organizations with which you
partner closely.

If you are selected, the CFPB will
provide the following:
§§ A full-time, fully funded, certified and trained,
professional financial coach integrated into your
organization. Coaches have experience providing
financial coaching to economically vulnerable
clients.
§§ Coaches have the following credentials from
leading industry providers:

úú Financial coaching certification provided by
Sage Financial Solutions.
§§ This coach is primarily managed by AFSC, in
coordination with a designated point of contact
at the local organization.
§§ The coach will be provided the basic resources
needed to do his/her job, including: laptop
computer, email address, work cell phone,
marketing materials, and business cards.

úú Accredited Financial Counselors with a
certification from the Association for Financial
Counseling and Planning Education (AFCPE).

Consumer Financial
Protection Bureau

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FINANCIAL COACHING INITIATIVE APPLICATION FORM

To participate
To be a good fit for this cohort, organizations must
serve low-income and/or economically vulnerable
people.
To be a good fit to host a financial coach, a potential
organization must have the capacity to integrate a
financial coach into programming from February
2017 – April 2019, provide an environment conducive
to effective coaching, and serve consumers of the
targeted population.
See below for more details about criteria for
interested organizations:
§§ Targeted population: Demonstrate a focus on
economically vulnerable consumers located
within or from the identified targeted geographic
areas. Additional attention will be given to
organizations that serve veterans.
§§ Client Volume: Have sufficient client volume to
support and sustain the utility of a financial coach.
The targeted number of clients served is at least
100 clients per year.
§§ Infrastructure and Operational Support:
Provide appropriate office space and working
environment for a financial coach to meet with
and coach clients. Provide coach with support in
integrating coaching into the services currently
being offered by the organization. If the
organization cannot supply enough coachable
clients, provide coach support to identify
and reach out to partner organizations in the
community.

an understanding of the benefit of helping the
people you serve become more financially
capable and how their increased financial
capability may help them achieve their goals
and the outcomes your organization’s services
support. Demonstrate an understanding of what
financial coaching is, how it would be beneficial
to the organization’s existing service offerings,
and how to integrate this service into the
organization (and in a way that connects with or
complements existing services).
§§ Organizational stability: Demonstrate success
and stability within the community.
§§ Client accessibility: Be accessible to low-income
and economically vulnerable consumers.
For example, have proximity to public
transportation for individuals without private
means of transportation and comply with ADA
requirements.
§§ Complementary services: Support services
complementary to financial coaching. For
example, services that indicate a longer-term,
future-oriented relationship with a client, or a
time of transition, including employment and
training service programs, education, working
with parents on goals related to their children.
We are interested in engaging organizations with a
variety of capacities and approaches. We welcome
both organizations experienced in the work of
financial empowerment and those interested
in learning how to integrate financial capability
topics into their work to increase the value of their
existing services.

§§ Commitment to financial coaching integration:
Commitment to integrating financial
empowerment into their work. Demonstrate

Consumer Financial
Protection Bureau

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FINANCIAL COACHING INITIATIVE APPLICATION FORM

Privacy Act Statement
The information you provide, including contact information, will only be used for managing participation in financial
empowerment initiatives sponsored by the Consumer Financial Protection Bureau (“CFPB”). The financial empowerment
initiatives are opportunities for public and private organizations or entities to receive tools, training, technical assistance,
and other services to help them reach low-income and economically vulnerable consumers. Identifying information
collected may be used by and disclosed to employees, contractors, agents, and others authorized by the CFPB to
receive this information to assist in related activities.
Information collected by the CFPB will be treated in accordance with the System of Records Notice (“SORN”), CFPB.021 –
CFPB Consumer Education and Engagement Records, 77 F.R. 60382.
This collection of information is authorized by Pub. L. No. 111-203, Title X, Sections 1013 and 1022, codified at 12 U.S.C.
§§ 5493 and 5512.
Your participation is voluntary, and you may withdraw participation at any time. You are not required to submit or provide
any identifying information; however, not doing so may result in the CFPB being unable to fulfill your request.

Paperwork Reduction Act Notice
According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and not withstanding
any other provision of law a person is not required to respond to a collection of information unless it displays a valid
OMB control number. The OMB control number for this collection is 3170-XXXX. It expires on MM/DD/YYYY. The time
required to complete this information collection is estimated to average approximately 5 hours per response. Comments
regarding this collection of information, including the estimated response time, suggestions for improving the usefulness
of the information, or suggestions for reducing the burden to respond to this collection should be submitted to Bureau
at the Consumer Financial Protection Bureau (Attention: PRA Office), 1700 G Street NW, Washington, DC 20552, or by
email to [email protected].

Consumer Financial
Protection Bureau

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FINANCIAL COACHING INITIATIVE APPLICATION FORM

Organization information

1

Please provide
your organization’s
contact information

ORGANIZATION NAME

ADDRESS

CITY

POINT OF CONTACT NAME

STATE

ZIP CODE

EMAIL

WORK PHONE

2

What is your
organization’s
mission and vision?

MISSION

VISION

3

Describe your
organization’s
geographic service
territory and the
populations it
serves

Consumer Financial
Protection Bureau

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FINANCIAL COACHING INITIATIVE APPLICATION FORM

Understanding of the project

4

5

6

Describe your
understanding of
and commitment
to this project’s
goals

Describe how
this project’s
services will be
integrated into
your organization’s
existing
service model,
including any
complementary
wrap-around
services

Describe your
organization’s
capacity to
undertake this
project, including
availability of
administrative
support

Consumer Financial
Protection Bureau

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FINANCIAL COACHING INITIATIVE APPLICATION FORM

Project goals

7

8

Describe how
your organization
ensures that clients
can access the
services you offer?

Within the next year, how many clients will your organization be able
to offer financial coaching services as a result of this effort?

clients

Submission instructions
Email this completed application along with the required documents listed below to
[email protected]. If your organization does not have any of these required documents,
provide an explanation in the body of your email.
§§ Completed application

§§ IRS Form 990

§§ Accessibility Policy

§§ Annual Report

§§ Most recent financial audit

§§ Nondiscrimination Policy



Email

[email protected]

Consumer Financial
Protection Bureau

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