Featured Programs:

Delta Health Alliance

Solutions For A Healthy Tomorrow

Financial Literacy Adult Enrollment Form & Survey

If you are interested in enrolling in DHA’s Financial Literacy program, please fill out the below enrollment form and take the brief intake survey.

Financial Literacy Adult Enrollment Form

DHA Financial Literacy Adult Enrollment Form

MM slash DD slash YYYY
Name
MM slash DD slash YYYY
Marital Status
Address
Which of the following best describes your employment status?
Are you a Veteran of the US Armed Forces?
Household income range
Highest educational attainment
Would you describe your housing as stable or temporary?
Do you have access to a telephone? (check all that apply)
Do you have access to internet in the home?
Do you have your own form of reliable transportation?

Financial Literacy Survey

Please fill out the below contact information and check the box that best fits.
Name
Could you benefit from participating in a financial literacy class?
Would you be willing to commit to participating in an online financial literacy class (one hour per week for 5-8 weeks)?
What shift do you work?
Which time works best for you?

Related Stories

DHA staff

GREAT grad fulfills dreams in face of COVID-19

Stacia Frazier wanted her life back and she wasn’t about to let the ...

Read More
DHA youth

CARES at DCPC

LELAND, Miss. – As an organization established to help transform the ...

Read More
Catch PE

CATCH P.E.

HOLLANDALE, Miss. – In most schools, structured physical education is a ...

Read More
College tour photo

Preparing Students for College

High school senior Raven Davis stood in the student union of the ...

Read More
View All Stories

Get Involved: