
Application Worksheet: The answers in your online application cannot be saved or worked on in multiple sessions, or viewed after you press the “submit” button upon completion. We recommend you use the below worksheet to assist your application process, and ensure you have a record of your application. After using this worksheet, please proceed to www.cybergrants.com/capitalone/financialliteracychallenge to complete your application.
Part A - screener questions (*answers to both questions must be “yes” to get to the next section)
1.
Question - Are you a 501(c)3, 501(c)4, 501(c)6, or a branch of city, state or local government (including a public school)?
Y or N
2.
Will you operate this specific financial education programming in Nassau and/or Suffolk
Counties on Long Island?
Y or N

 Part B - Contact information
1.
What is the name of your organization/group/school?
2.
What is your name?
3.
What is your email address?
4.
What is your phone number?
5.
What is your address?
6.
What is your relationship to the organization/group/school?
Part C - About the organization/group/school
1

1.
What is the mission of your organization/group/school? (600 character limit)
2.
What audience does your organization/group/school serve?
 Check all that apply: o
Pre-School Age Students o Elementary School Age Students o Middle School Age Students o High School Age Students o College Age Students o Young Adults (age 20-40) o Adults (40-65) o Seniors (65+) o Low-Income Communities o Middle-Income Communities o High-Income Communities o Minority Communities
3.
How many members/clients/students does your organization/group/school have?
Choose one: o
1-15 individuals o
15-50 individuals o
50-100 individuals o
100+ individuals
4.
What geography does your organization/group/school serve? Check all that apply: o Suffolk County o Nassau County
5.
Does your organization/group/school currently do any financial education programming?
Y or N
5a. (If answer to #5 is Y) - If your organization/group/school does financial education programming, please describe the programs (600 character limit)
2

 Part D - About the financial education program
1.
Describe what kind of financial education programming your organization/group/school will do as a part of the Financial Literacy Challenge on Long Island between September
2013 and May 2014? (1,200 character limit)
2.
What are two or three specific anticipated outcomes of your project? (400 character limit)
3.
Are you interested in leveraging any of Capital One Bank's existing resources for financial education?
Y or N
3a. (If answer to #3 is Y) - If you would want to leverage Capital One Bank's existing resources for financial education, which would you want to use? Check all that apply: o Bank It Elementary (audience: 3 rd -6 th grade students and their parents) o Vault ™ - Understanding Money (audience: 4 th -6 th grade students) o Bank It (audience: 6 th -12 th grade students and their parents) o EverFi™ - Financial Literacy (audience: high school students) o JA Finance Park® Virtual (audience: middle - high school students) o Buttonwood™ - Personal Finance and Student Loan Management
(audience: college students) o MoneyWi$e (audience: adults)
3

4.
Would you want to leverage any Capital One Bank volunteers for your financial education program?
Y or N
4a. (if answer to #4 is Y) – If so, how many? o
1-5 o
5-10 o
10-20
4b. (if answer to #4 is Y) – What role would the volunteer(s) have in the program?
(200 character limit)
4c. (if answer to #4 is Y) – How often would you want volunteers? Check-one: o Weekly o Bi-Weekly o Monthly o 1-3 times during the program o 4-6 times during the program
5.
What population on Long Island would your program serve? Check all that apply: o
Pre-School Age Students o
Elementary School Age Students o
Middle School Age Students o
High School Age Students o
College Age Students o Young Adults (age 20-40) o Adults (40-65) o Seniors (65+) o Low-Income Communities o Middle-Income Communities o High-Income Communities o Minority Communities
6.
Approximately how many people on Long Island would your program serve from
September 2013 to May 2014? Choose one: o 1-15 individuals o 15-50 individuals o 50-100 individuals o 100+ individuals
7.
What Long Island geography would your program serve? Check all that apply:
4

o Suffolk County o Nassau County
8.
What would make your organization/group/school a strong participant in the Financial
Literacy Challenge? (600 character limit)
9.
Why is financial literacy important for your organization? (600 character limit)
10.
Anything else we should know? (600 character limit)
5