Appendix D: Matrix of Current Instructors

Appendix D: Matrix of Current Instructors

(Application for Approval as a Provider of a Personal Financial Management Instructional Course)

Name of Provider: Other business names used at this location, if any: Street address:
Total number of personnel at this location: __________	Instructor Names
	1.	2.	3.	4.		5.		6.	7.	8.	9.	10. (Copy this page for additional employees)
Supervisor (check)
EDUCATION - Highest Degree Received (check one)
High School
A.D.
B.A./B.S.
Graduate (M.S., J.D., Ph.D.)
Other (specify)*
INSTRUCTOR CERTIFICATION (check all that apply)
Certified as a Credit or Financial Counselor*
Course of Study*
CFP
RFC
CPA
EXPERIENCE (state years of experience)
Credit Counseling
Financial Management - Financial Planning
Consumer Credit Education
Consumer Economics
Other (specify)*
ANNUAL CONTINUING EDUCATION
State year of most recent completion of continuing education course.

* Disclose on separate page. See Section 7, Appendix D, of Instructions for additional detail.