Application Forms

DRAFT FOR INTERNAL REVIEW ONLY | cfpb_ymyg_cohort_application_r4-1

APPLICATION FOR PARTICIPATION IN THE

 2017 Your Money, Your Goals Cohort

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

The Consumer Financial Protection Bureau (CFPB) will provide Your Money, Your
Goals toolkits, training, and technical assistance to up to 25 organizations across
the country that are committed to helping financially empower the populations they
serve. This is not an opportunity for a grant, contract, sub-contract, or funding. This
is an opportunity for public and private organizations or entities to receive consumer
education materials, training that prepares your organization to train staff, volunteers,
or other community partners, and technical assistance to integrate financial
empowerment and capability strategies into their existing service delivery model.
The CFPB will support members of the 2017 Cohort in using the Your Money, Your
Goals toolkit to help build the financial capability of those they serve. The toolkit is
designed for use in organizations that rely on staff or volunteers to coach, counsel,
or mentor the people they serve. The toolkit is available in English and Spanish on
our website (consumerfinance.gov/your-money-your-goals). Organizations have
used various innovative approaches to implement Your Money, Your Goals training,
tailoring it to their structure, mission, modes of service delivery, and clientele.
When combined with the training, the toolkit includes the resources that staff and
volunteers need to help people set goals, choose financial products, and build skills
in managing money, credit, and debt.

If you are selected, the CFPB will
provide the following:
§§ A Train-the-Trainer event (in-person or webinar)
for members of participating organizations
designated as trainers. These trainers would then
lead workshops for frontline service providers,
volunteers, or community partners to help them
use Your Money, Your Goals in their work.

Consumer Financial
Protection Bureau

§§ Hard copies of the complete toolkit for the staff/
volunteers the organization trains.
§§ Technical assistance in determining training
priorities and adapting use of the toolkit for the
organization or program.
§§ Coordination calls for all cohort participants at
key points during the year.

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YOUR MONEY, YOUR GOALS COHORT APPLICATION FORM

To participate
The CFPB anticipates that training and technical
assistance will begin in April 2017 and conclude in
September 2017.
To be a good fit for this cohort, organizations must
serve low-income and/or economically vulnerable
people. Other criteria include:
§§ Commitment to integrating financial
empowerment into their work. Demonstrate
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.

integrate financial capability topics into their work to
increase the value of their existing services.
As you consider how you would implement Your
Money, Your Goals, you may find the framework
detailed in Building Financial Capability: A
Planning Guide for Integrated Services (acf.hhs.
gov/sites/default/files/ocs/afi_resource_guide_
building_financial_capability_final.pdf ) useful.
It was developed to help organizations integrate
financial capability strategies into their work by
the Administration for Children and Families, U.S.
Department of Health & Human Servicess.

§§ Staff capacity for training on and use of the
Your Money, Your Goals toolkit. Demonstrate
capacity to dedicate staff time to lead training of
other staff within the organizations and/or other
partners within your community.
§§ Staff capacity to use toolkit with clients.
Demonstrate capacity to commit staff or
volunteer time directly to using the Your Money,
Your Goals toolkit with low-income and/or
economically vulnerable populations.
§§ Commitment to collect and return training
surveys. Willingness to fulfill survey collection
responsibilities, which enable us to continue to
improve the toolkit and measure its impact.
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

Consumer Financial
Protection Bureau

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YOUR MONEY, YOUR GOALS COHORT 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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YOUR MONEY, YOUR GOALS COHORT 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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YOUR MONEY, YOUR GOALS COHORT 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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YOUR MONEY, YOUR GOALS COHORT APPLICATION FORM

Project goals

7

How many trainers will your organization plan to have trained
through this effort?

trainers

8

Within the next year, how many trainings will your organization hold
after your trainers are trained?

trainings

9

Within the next year, how many frontline staff, volunteers, or
community partners does your organization plan to train?

staff/volunteers
/partners

10

Within the next year, how many clients will your organization reach
as a result of this effort?

clients

Information sharing

11

Can your organization commit to administering pre- and post-surveys to all
participants of trainings your organization will hold and to share those surveys
with the CFPB?

YES

NO

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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