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Individual Development Accounts (I.D.A)

Individual Development Accounts
Registration Form

Full Name
Male/Female
Birthdate
Social security no.
Street #
City State Zip
E-Mail
Your Website
Day Phone
Evening Phone
Work phone
  Are you a refugee or a former refugee?
Yes No
  Are you currently employed?
Yes No
  Do you earn less than 200% of the federal poverty guidelines?
Yes No

($23,880 per year for a family of 2, $36,200 for a family of 4.)
Comment

I understand that the information contained on this application is complete and accurate to the best of my knowledge and that this application will be retained by the Individual Development Accounts. I will be expected to provide the program with business and personal financial information for a period of three (3) years. Having carefully read this application, I hereby authorize the release of any of this information with other
individuals, agencies and organizations for the purpose of securing funding, training and business financing.


Individual Development Accounts (I.D.A)

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