FAIM Progam Forms

If you are unsure which grant a FAIM client is enrolled in – locate the “Intended Use” field on the FAIM account statement you pull from VistaShare each month.  The four digits listed after their chosen asset represent the grant they are enrolled in. 

FAIM enrollment forms below have been updated for State Grant 2086 – always use the current forms.  Enrollment in Grant 2086 opened on 2/20/2024 and will temporarily freeze on 3/22/2024.  The Admin team will review allocations and announce when enrollment may reopen.  

Pre-Post Enrollment Assessment Tools / Budget & Training Forms

• Wheel of Finance Worksheet
• Household Budget Estimate Form – March 2021
• Assessment – Financial Knowledge at Application or Exit
• Assessment – Self Efficacy
• Assessment – Financial Practices
• Assessment – Financial Products and Services
• Assessment – Financial Knowledge Pre-Post Training
• Go to FAIM Coordinators tab on main page then click on Training for financial wellness curriculum
• Financial Management Training Certificate 2-23-2024
• Asset-specific Training Certificate 2-23-2024

Enrollment Forms

Please note Bremer Bank does NOT accept electronic signatures on any forms sent to them, client and coach must physically sign where indicated on forms.

• FAIM Local Agency Wait List Form
• 2024 Federal Poverty Guideline
• FAIM Saving Affordability Calculator – updated 3/6/2024 – Send to FAIM Admin.  Complete with client at screening.
• FAIM Pre-Enrollment Screening Tool – 2/22/2024 – Send to FAIM Admin.  Pre-screen before completing an application.
• FAIM Coach Checklist – Application & Account Opening – updated 3/5/2024– checklist for coach reference.
• Grant 2086 FAIM Application – Core 4 Assets 3/6/2024  – Send to FAIM Admin.
• FAIM Contract Agreement & Beneficiary Form – 3/6/2024 – Send to FAIM Admin.
• FAIM – Self-Employment Income Worksheet – Feb 2022
• FAIM-Bremer Account Opening Forms Packet – 3/6/2024 – Send to FAIM Admin & Bremer.
• Optional Bremer – Automatic Transfer Authorization Form 1-30-2024 – Send to FAIM Admin & Bremer.
• Optional FAIM Account Info – Direct Deposit / Auto Transfer Setup 1/30/2024  – Give to client.

Payout Request Forms

• Coach Payout Checklist – PS Education or Business – updated 3/6/2024 – for coach reference.
• Coach Payout Checklist – Home or Vehicle Purchase – updated 3/6/2024 – for coach reference.
• FAIM Payout Request Forms PACKET – new 3/6/2024 – Send to FAIM Admin
• W9 Form – Send to FAIM Admin required if vendor is not in WCMCA’s fiscal system or inactive 12 months.
• See below for additional documents required with the payout request for each asset track
• If this will be the final payout for the client, also complete the Exit forms.

Business Asset Forms and Templates

• FAIM – Guide to Business Development Requirements – Updated 4-26-2022 – share with business asset clients
• FAIM – Asset-Specific Training Hours Tracking Form – keep in local file
• FAIM Business Plan – 2020 Template  Send in – share with business asset clients
• FAIM Use of Funds & Budget Projection Spreadsheets March 2022 – Template  Send in – share with business asset clients
• FAIM Business Plan Approval Form – Fillable -March 2022 – Send in  Send in – share with business asset clients
• W9 Form – Send in – Business must have an EIN even if operating as sole proprietor.  Do not list SSN on the W9 for business asset
• Send with business payout request:  copy of EIN assignment letter from IRS, registration of business with MN Secretary of State, and documentation of business checking account opened at an insured bank or credit union
• Business Asset Online Resources – share with business asset clients for free help with business plan creation and approval
• Locate a Small Business Development Center (SBDC) in MN:  https://mn.gov/deed/business/help/sbdc/
  • SBDC Resource:  A Guide to Starting a Business in Minnesota
  • SCORE:   Find Your Business Mentor | SCORE 
  • Sales Tax Resources:  http://www.thestc.com/ or http://www.zip2tax.com/
• Vehicle purchase guidance – for business asset
• Market Research and Pricing
• Small Business Marketing

Education Asset Forms

• FAIM – Third Party Billing Form – updated 3/6/2024  Send in with payout request. Send to the college PRIOR to drop/add date.
• Send with payout request:  student must provide an itemized college bill, class list, and bookstore receipt (if applicable)
• FAIM – Asset-Specific Training Hours Tracking Form – keep in local file
• Career Assessment Tool
• Education Tracking Form
• Sample – College Fee Statement

Home Purchase Asset Forms

• Loan Estimate – send with payout request forms
• Closing Disclosure (CD) – send final, signed copy after closing date.  Also required for principal reduction payout – if home was purchased after enrolling in FAIM but before meeting the minimum enrollment requirement.
• Current Mortgage Statement – send with copy of final CD if doing a principal reduction payout.  Another copy is required within 30 days of the payout to document that the FAIM payment was applied to principal only.
• Household Budget Estimate Form – located in Financial Training/Assessment Tools section
• FAIM – Asset-Specific Training Hours Tracking Form – keep in local file
• Mortgage Qualifier Form

Vehicle Purchase Asset

• Household Budget Estimate Form – in Financial Training/Assessment Tools section.  Participant’s budget must support cost of vehicle ownership
• FAIM Guide for Vehicle Purchase – State Grant 2005 & 2086 – Updated 3/6/2024
• FAIM Guide for Vehicle Purchase – State Grant 2085 – Updated 3/6/2024
• Car Buying Education Material – First DRAFT Nov 2021
• FAIM – Asset-Specific Training Hours Tracking Form – keep in local file
• FAIM – Used Vehicle Inspection Form – June 2022  – send with payout request
• Vehicle Research Comparison Spreadsheet – new 3/6/2024 – template for vehicle research and comparison
• Vehicle Service Record Tracking Template – template for clients to track their vehicle service record.
• Letter of Guarantee – dealership may request verification of pending FAIM payment:
  • Coach must submit all vehicle documentation for the payout to FAIM Admin for review. 
  • If vehicle is approved, Admin will complete the form and send to the coach.
• Required with payout request forms: 
  • Copy of FAIM participant’s valid Minnesota driver’s license
  • Copy of vehicle insurance quote from agent – for the vehicle being purchased.
  • KBB or NADA market value printout – dealer’s selling price must be under high retail value.
  • Copy of Vehicle Inspection Report – AND – Repair Estimate for anything noted on the inspection.
  • Copy of Vehicle Purchase Agreement/Contract
    • After payment – another copy required with FAIM funds listed.
  • Copy of vehicle title (both sides) – AND lien release (if applicable) 
    • After payment – copy of title transfer document showing FAIM participant as sole owner.
  • If applicable – Copy of loan document detailing terms

Exit Forms

• FAIM Exit – Account Closing Checklist 2019 for reference
• FAIM Exit Form – updated 3/6/2024 – Send to FAIM Admin 
• FAIM Savings Account Closure Form – updated 3/6/2024 Send to FAIM Admin – wait for okay to send to Bremer 
• FAIM Education Notes Form – found in Payout Request Forms section – send in if client exits without a payout
• FAIM Participant Survey 2018 – Send in Optional client survey

Program Forms

• 2024 FAIM Brochure is available on the “About FAIM” page
• FAIM – Client Contact Log  keep in local client file.
• FAIM – Local Client File Cover Sheet – updated March 2021
• FAIM Now What Brochure – Updated 2-7-2022
• FAIM Timeline – Updated 3-3-2022
• FAIM Contract Amendment Request Form – Jan 2022 Fillable – send in
• FAIM Contract Extension Request Form – Jan 2022 Fillable – send in
• FAIM Waiver of Odd Cents Form – Jan 2022 Fillable – Send in
• FAIM Excess Savings Withdrawal Form – Jan 2022 Fillable – State Grant – Send in
• FAIM One-Time Emergency Withdrawal Form – coach must contact FAIM Admin to request completion
• Enrollment Denial Letter – March 2021 Fillable
• Enrollment Termination Letter – April 2021 Fillable

Cornerstone Advocacy Service – Forms for CAS Private Match Enrollees

• Cornerstone Coach – Private Match Payout Request Checklist – 5-5-2022 – CAS Payout Checklist
• Cornerstone Exit Form Fillable May 2022 – Send in – CAS Exit form