Money Smart Alliance Enrollment SurveyForm

OMB Number: 3064-0127

Expiration Date: 3/31/2017

Part II: Text for a new webpage that will appear when you click “join” above.

Join the Money Smart Alliance Program

Alliance members agree to use or promote the Money Smart curriculum. Most often, this is done by teaching Money Smart or training others to teach it. Alliance members also provide feedback to the FDIC that can help improve Money Smart.

Please complete this form to join the Alliance.

Organization Name:
Organization type: (Other organizational types are not eligible to join the Alliance at this time) (check one):	Federally-insured financial institution Non-profit organization that has been recognized as tax-exempt by the IRS Federal agency K-12 school or school district College or university Other state or local government agency or entity
Contact name:
Contact e-mail address:
Contact telephone number:
We use these Money Smart products: (check all that apply):	Money Smart for Small Businesses Instructor-led curriculum for: Young People Young Adults Adults Older Adults Small Businesses Self-paced curriculum: CBI Podcast
Or organization uses Money Smart by: (check all that apply)	Teaching it to others Promoting it to organizations that can use it Promoting the self-paced versions to consumers Funding or supporting organizations that use it
We use Money Smart in these state(s):
We use Money Smart products in these languages: (check all that apply)	Braille/Large Print English Chinese Haitian Creole Hindi Hmong Korean Russian Spanish Vietnamese
Consumers who want Money Smart training can contact us.	Yes No
I want the information I provide above to be available on the FDIC website.	Yes No
Membership in the Money Smart Alliance does not constitute an endorsement of FDIC of any product, service, or position of Alliance members. Alliance Members may not use the FDIC name or logo to imply an FDIC endorsement of its products, services, or positions. Alliance membership may be terminated by either party at any time. Alliance memberships are for renewable three-year terms.
By clicking the box below, you reflect that you agree with the statement above and you agree that the information you supplied above is accurate.

ESTIMATED REPORTING BURDEN

Paperwork Reduction Act Notice. Public reporting burden for this collection of information is estimated to average 5 minutes per response, including the time for completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing the burden, to the FDIC PRA Clearance Officer, 550 17^th Street, N.W., Washington, DC 20429; and to the Office of Management and Budget, Paperwork Reduction Project (3064-0127), Washington, DC 20504.