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29
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1
Name
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First Name
Last Name
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2
Email
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3
Kindly answer a series of questions and rate yourself as you see fit regarding your finances.
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4
What are your initial feelings when thinking about your finances?
Excited
Confident
Optimistic
Neutral
Fear
Lost
Dread
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5
How would you rate your budgeting skills?
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Beginning
Expert
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6
How would you rate your financial knowledge?
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Poor
Strong
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7
How satisfied are you with your ability to meet your financial obligations?
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5
Not Satisfied
Satisfied
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8
How satisfied are you with your income that your current job or career provides you?
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5
Not Satisfied
Satisfied
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9
How satisfied are you with your spending habits?
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5
Not Satisfied
Satisfied
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10
How satisfied are you with the level of debt you carry?
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Not Satisfied
Satisfied
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11
How satisfied are you with your current investment choices?
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Not Satisfied
Satisfied
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12
How satisfied are you with the level of employee benefits you receive?
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5
Not Satisfied
Satisfied
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13
How satisfied are you with your estate plan?
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5
Not Satisfied
Satisfied
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14
How satisfied are you with your ability to provide financial help to family members?
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5
Not Satisfied
Satisfied
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15
How satisfied are you with the level of financial education you have attained?
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5
Not Satisfied
Satisfied
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16
How satisfied are you with your ability to communicate about your financial matters?
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5
Not Satisfied
Satisfied
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17
How satisfied are you with the feelings you have about your money life?
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5
Not Satisfied
Satisfied
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18
Do financial issues cause stress or strain in the relationships that are important to you?
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Yes
Not at All
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19
Are you satisfied with the working relationships you have with your financial service providers (i.e., insurance agent, banker, broker,financial planner, accountant)?
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Not Satisfied
Satisfied
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20
Please indicate your feelings regarding the following financial questions below with 1 being= not satisfied and 5 being= very satisfied
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5<br>
Are you satisfied with building a sufficient retirement nest egg?
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Are you satisfied with the amount of money that you save and invest on a regular basis?
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Are you satisfied with the “extras” that you are able to buy for yourself and/or loved ones?
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Are you satisfied with the level and quality of insurance protection you currently have?
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Are you satisfied with your style of personal budgeting and financial record management?
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Are you satisfied with your level of charitable giving?
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Are you satisfied with how you respond emotionally to your personal finance issues?
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Are you satisfied with building a sufficient retirement nest egg?
Are you satisfied with the amount of money that you save and invest on a regular basis?
Are you satisfied with the “extras” that you are able to buy for yourself and/or loved ones?
Are you satisfied with the level and quality of insurance protection you currently have?
Are you satisfied with your style of personal budgeting and financial record management?
Are you satisfied with your level of charitable giving?
Are you satisfied with how you respond emotionally to your personal finance issues?
1
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5<br>
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5<br>
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5<br>
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5<br>
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5<br>
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5<br>
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5<br>
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21
What would you do differently if you ‘had the money,’ if money was not a limiting factor?
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22
What are some of the factors or circumstances in your life that could affect your financial plan?
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23
When making financial decisions, who or what are your main sources of financial information?
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24
Name those individuals who will be affected by the financial decisions you make
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25
What would you say are your areas of improvement in terms of maintaining a budget?
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26
What areas of your financial habits you think you could improve on?
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27
What are the major purchases that you are most focused on right now?
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28
Where do you see yourself financially in 5 years?
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29
What are your strengths and weaknesses in regards to your finances? How will you overcome them?
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