Cooperative Extension Service * College of Tropical Agriculture and Human Resources *
University of Hawaii at Manoa
MONEY 2000
Enrollment Form
Make Check Payable to: RCUH 1497 Amount Enclosed: $__________
Mail this form with your check, Topics of Interest, and Demographic Data to:
MONEY 2000
U.H. CES
1955 East West Road
Honolulu, HI 96822
Individual ($10.00)
Name ________________________________________________________________________
Address ______________________________________________________________________
City __________________________________ Zip Code ___________________________
Phone (I prefer you to phone during the): Day __________ Evening __________
Email _________________________________ FAX _______________________________
My MONEY 2000 goal is:
I will save/invest $__________________. I will reduce my debt by $___________________.
TOTAL: I will be $__________________ richer by the year 2000!
FAMILY HOUSEHOLD ($10.00)
Family Head of Household ($10.00) Name ____________________________________
Family Household Member Name ____________________________________
(one additional, no charge)
Child/Youth Family Household Name ____________________________________
Member (18 years or younger, Name ____________________________________
no charge) Name ____________________________________
Family Household Address:
_____________________________________________________________________________
City ___________________________________ Zip Code ___________________________
Phone (I prefer you to phone during the): Day __________ Evening __________
Email _________________________________ FAX _______________________________
Money 2000 Goals
Name |
I will increase my savings by |
I will decrease my debt by |
TOTAL Family Household Goal:
__________________________
Savings____________________
Debt______________________
CLUB
Enrollment option is available at $5.00 per individual member. Call for details and forms.
MONEY 2000
Topics of Interest
Hawaii Cooperative Extension Service seeks to provide practical education for residents and decision makers in the State of Hawaii. To assist us in future planning, please check the topics that you would like more information about.
BASIC MONEY MANAGEMENT SKILLS
A _____ Setting Financial Goals
B _____ Making A Spending Plan/Budget
C _____ Savings
D _____ Organizing A Record Keeping System
E _____ Tracking Expenses and Spending
F _____ Managing Irregular Income
MONEY AND RELATIONSHIPS
G _____ Starting Out Together - Financial Realities of Marriage
H _____ Young Children Learn About Money
I _____ Adolescents Learn Financial Responsibility
J _____ Communicating with Family Members about Money
K _____ Adjusting to Suddenly Reduced Income
L _____ Financial Concerns at Divorce
M _____ Financial Matters for Remarried Persons
N _____ When Adult Children Live/Return Home
O _____ Caring for Elderly Relatives
P _____ Planning for Retirement
Q _____ Estate Planning - Financial Concerns at Death
SPENDING WISELY
R _____ Clothing On A Budget
S _____ Food Shopping
T _____ Living on A Reduced Income
U _____ Home Buying
V _____ Home Ownership
W _____ Buying A Car
INSURANCE
X _____ Auto
Y _____ Life
Z _____ Health
AA _____ Property
BB _____ Disability
CC _____ Long-term Care
UNDERSTANDING BANK SERVICES
DD _____ Electronic Banking Services (ATM and Debit Cards, on-line banking)
EE _____ Balancing A Bank Statement
FF _____ Savings Options
GG _____ Checking Account Options
CREDIT MANAGEMENT
HH _____ Shopping for Credit
II _____ Building A Credit Record
JJ _____ Reducing Consumer Debt
KK _____ Using Home Equity
LL _____ Reverse Mortgages
SAVINGS AND INVESTMENTS
MM _____ Introduction to Investment Opportunities
NN _____ Certificates of Deposit
OO _____ Mutual Funds
PP _____ Stocks and Bonds
QQ ______ U.S. Savings Bonds/Treasury Bills
Listed below are possible ways to receive information. Rate on a scale of 1-5 with 5 being the "best" and 1 being the "worst". Please tell us how you like to receive information.
Seminar 1 2 3 4 5
Workshop 1 2 3 4 5
Group Meeting 1 2 3 4 5
Exhibits at Malls, Libraries, and Bank Lobbies 1 2 3 4 5
Lunch & Learn Workshops at Place of Employment 1 2 3 4 5
Money Management/Credit Fair 1 2 3 4 5
Fact Sheets 1 2 3 4 5
Home Study Courses 1 2 3 4 5
Video Tapes 1 2 3 4 5
Audio Cassette Tapes 1 2 3 4 5
Computer Budget Analysis Program 1 2 3 4 5
Individual Instruction 1 2 3 4 5
Community/Cable/T.V. Programs 1 2 3 4 5
Newsletters 1 2 3 4 5
Videoconference 1 2 3 4 5
MONEY 2000
Demographic Data
This information will be held confidential. All demographic data will be combined for summary and evaluation research. Please put and "X" in front of the most appropriate answer for each question.
1. What is your age?
A _____ 18 years and under
B _____ 19-24 years
C _____ 25-34 years
D _____ 35-44 years
E _____ 45-54 years
F _____ 55-64 years
G _____ 65 years and over
2. Which of the following best describes your household?
A _____ Single (widowed, divorced, never married or no dependent children)
B _____ Single Parent (dependent children)
C _____ Married without children
D _____ Married with children
E _____ Other (please describe)
3. If you have dependent children, please write the number in each of the blanks.
A _____ Preschoolers
B _____ Elementary school students (grades K-8)
C _____ Secondary school students (grades 9-12)
D _____ College students
E _____ Other (please describe)
4. What is your highest level of education?
A _____ Less than high school
B _____ Completed high school
C _____ Some college
D _____ Two year degree
E _____ Four year degree
F _____ Advanced degree
5. Are you?
A _____ Male
B _____ Female
6. What is your racial/ethnic origin?
A _____ White
B _____ American Indian
C _____ Black/African-American
D _____ Asian
E _____ Hispanic
F _____ Pacific Islander
G _____ Hawaiian/Part Hawaiian
H _____ Other (please describe)
7. Last year, about how much money did you get to live on? This should include paychecks, social security, food stamps, money from retirement checks, money from other government programs and money from other people such as family or friends.
A _____ $15,000 and under
B _____ $15,001-$30,000
C _____ $30,001-$45,000
D _____ $45,001-$65,000
E _____ over $65,000
This information will only be used by Hawaii Cooperative Extension Service for research and documentation of MONEY 2000 program efforts. Your personal privacy will be carefully guarded. Hawaii Cooperative Extension Service is interested in helping you achieve your goals and will not sell or divulge any personal information you share with any other agency or organization.
Return to: MONEY 2000
Cooperative Extension Service
1955 East West Road
Honolulu, HI 96822-2313COOPERATIVE EXTENSION SERVICE UNIVERSITY OF HAWAII AT MANOA COLLEGE OF TROPICAL AGRICULTURE AND HUMAN RESOURCES 3050 MAILE WAY HONOLULU, HAWAII 96822. The UH-CTAHR Cooperative Extension Service and the U.S. Department of Agriculture cooperate in presenting to the people of Hawaii programs and services without regard to race, sex, age, religion, color, national origin, ancestry, disability, marital status, arrest and court record, sexual orientation, or veteran status. The University is an equal opportunity, affirmative action institution.