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Home
Passport to Financial Success Application
Home
Passport to Financial Success Application
Passport to Financial Success Application
First Name
Last Name
Street Address
City
State
Zip Code
Phone Number
Email Address
Household Size
One
Two
Three
Four
Five
Six or more
Other…
Number in your Household
Work Status
Employed Full-Time
Unemployed (short-term, 6 months or less)
Unemployed (not in labor force)
Employed Part-time
Unemployed (long-term, more than 6 months)
Retired
Household Income
One or More Sources of Income
No Income
Source of Household Income (choose all that apply)
TANF
Pension
SSI
Social Security
General Assistance
Employment + Other Source
Employment Only
Unemployment Insurance
Other…
Explain Other:
What is your Approximate Annual Household Income?
Less than $10,000
$10,000-$14,999
$15,000-$24,999
$25,000-$34,999
$35,000-$49,000
$50,000 or above
Housing
Own
Rent
Other Permanent Housing
Homeless
Other
Have you participated in this program before?
Yes
No
Gender
Female
Male
Prefer Not to Say
Age
18-24
25-34
35-49
50-65
65-74
75-years or older
Ethnicity
Hispanic, Latino or Spanish Origin
Not Hispanic, Latino, or Spanish Origin
Race (choose all that apply)
White
Black or African American
Asian
American Indian or Alaska Native
Native Hawaiian and Other Pacific Islander
Multi-Race (any two or more from above)
Other
Other…
List other ethnicity
Education level
Grades 0-8
Grades 9-12/Non-Graduate
High School Graduate
GED/Equivalency Diploma
Some College
College Degree
Masters Degree
Doctoral Degree
Other…
Explain Other:
Health Insurance
Yes
No
Disabled
Yes
No
Military Status
Veteran
Active Military
Never Served in Military
Main Language Spoken at Home
English
Spanish
Other…
Other Language:
Do you have a savings account?
Yes
No
Are you willing to open a saving account by September 9, 2025?
Yes
No
Are you an employee of the City of Las Cruces?
Yes
No
Are you related to a Las Cruces City employee?
Yes
No
How did you hear about this program?
Submit
Leave this field blank
