Appendix D: Matrix of Current Counselors

Appendix D: Matrix of Current Counselors

(Application for Approval as a Nonprofit Budget and Credit Counseling Agency)

Name of Agency: Other business names used at this location, if any: Street address:
Total number of personnel at this location: __________	Counselor 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)*
COUNSELOR CERTIFICATION (check all that apply)
Certified by Independent Organization*
Course of Study*
CFP
RFC
CPA
EXPERIENCE (state years of experience)
Credit Counseling
Financial Management - Financial Planning
Consumer Credit Education
Consumer Economics
Other (specify)*
BACKGROUND CHECK (state the year of the criminal background check and check if no conviction for any felony, or crime involving fraud, dishonesty, or false statements)
Criminal Check (Year)
No Criminal Conviction
ANNUAL CONTINUING EDUCATION
State year of most recent completion of continuing education course.

* Disclose on separate page. See Section 8, Appendix D, of Instructions for additional detail.