CALM Matrix Assessment Introduction
In this assessment you will be presented 4 Categories: Workforce, Financial, Work Supports & Health & Wellness. Within these categories are Life Domains these are a section of your day to day life in relation to the main category. Please select the statement that best represents you.
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CALM Matrix Assessment
Please complete the following and hit next to begin the CALM Matrix Assessment.
Full Name
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First Name
Middle Name
Last Name
Email
*
example@example.com
Employment Specialist Name
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Workforce
Please select the statement that best represents you in relation to the Life Domain.
Employment & Income
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1. I am unemployed and have no income.
2. I am unemployed and my income is mostly from public assistance or unemployment insurance.
3. I am employed temporary, part-time or seasonal, at minimum wage.
4. I am employed full-time. I earn enough to pay my bills, and started to save.
5. I am employed full-time or a successful entrepreneur. I earn enough to pay my bills and to save.
Education
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1. I don't have a GED or high school diploma or am working on my GED or high school diploma.
2. I have a GED or high school diploma.
3. I have some college credits, a certificate, or license.
4. I have a degree or have completed an advanced training program.
5. I have a degree or have completed a higher level training program in a growing field.
Workplace Skills
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1. I am not confident in my workplace skills (such as communication, teamwork, and critical thinking).
2. I am somewhat confident in my workplace skills (such as communication, teamwork, and critical thinking).
3. I am confident in my workplace skills (such as communication, teamwork, and critical thinking).
4. I am very confident in my workplace skills (such as communication, teamwork, and critical thinking).
5. I am extremely confident in my workplace skills (such as communication, teamwork, and critical thinking).
Work Experience
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1. I have not been able to find or keep a job.
2. I have not been able to find or keep a job for the last 6 months, or might lose my present job.
3. I have a job that meets my day-to-day needs.
4. I have a job with opportunities for advancement.
5. I have a job with opportunities for advancement, and have been employed in my present job for over a year.
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Financial
Please select the statement that best represents you in relation to the Life Domain.
Money Management
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1. I am unable to pay any or most of my bills. I almost never budget.
2. I am unable to pay some of my bills. I rarely budget.
3. I am able to pay all of my bills. I sometimes budget.
4. I am able to pay all of my bills. I budget fairly often. I have started saving for emergencies.
5. I am able to pay all of my bills. I budget very often. I have money to save and invest.
Saving & Investing
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1. I have no savings.
2. I have saved less than 3 months living expenses.
3. I have saved 3 months living expenses.
4. I have saved more than 3 months living expenses. I sometimes make deposits into savings for emergency, retirement or large purchases.
5. I have saved more than 3 months living expenses. I make regular deposits into long term savings for emergency, retirement or large purchases.
Credit Management
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1. Most or all of my accounts are in collections. I am making minimum or no payments.
2. Some of my accounts are in collections. I am making minimum or low payments.
3. None of my accounts are in collections. I am making more than the minimum payment, but my balances are high.
4. All of my accounts are in good standing, I am making more than the minimum payment, and my balances are moderate.
5. All of my accounts are in good standing, I am making more than the minimum payment, and my balances are low.
Using Financial Services
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1. I don't have a bank account. I frequently use check cashing, payday loans, or pawn services.
2. I have a checking account. I sometimes use check cashing, payday loans, or pawn services.
3. I have a checking and savings account, but sometimes overdraft or have insufficient funds.
4. I have a checking and savings account, and rarely overdraft or have insufficient funds.
5. I have a checking, savings, and retirement account and never overdraft or have insufficient funds.
Insurance & Protections
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1. I do not have insurance.
2. I have insurance, but it is incomplete for my needs.
3. I have life, auto, and/or rental or homeowner's insurance but the coverage is low.
4. I have life, auto, and rental or homeowner's insurance, and the coverage is medium.
5. I have life, auto, and rental or homeowner's insurance, and the coverage is high.
Taxes
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1. I do not have options for cost-effective tax preparation. I am not familiar with tax credits.
2. I have little options for cost-effective tax preparation. I am not very familiar with tax credits.
3. I have some cost-effective tax preparation options. I am somewhat familiar with tax credits.
4. I have cost-effective tax preparation options. I am familiar with tax credits.
5. I have many cost-effective tax preparation options. I am very familiar with tax credits.
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Work Supports
Please select the statement that best represents you in relation to the Life Domain.
Housing
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1. I live in: a shelter, my car, am couch surfing, not on the lease, or I am homeless.
2. I live in transitional housing, or unaffordable housing. I am at risk of losing my housing.
3. I live in a subsidized rental, Section 8, or public housing.
4. I live in non-subsidized, affordable housing, but my choices are limited due to my income.
5. I live in the housing of my choice - I own my home or rent non-subsidized housing.
Transportation
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1. I do not have access to transportation -- public or private.
2. I have transportation, but it is unreliable. I am often late or absent from work or school due to transportation issues.
3. I have reliable transportation, but no backup plan. I am sometimes late or absent from work or school due to transportation issues.
4. I have reliable transportation with a backup plan. I am rarely late or absent from work or school due to transportation issues.
5. I have quality transportation with a backup plan. I am never late or absent from work or school due to transportation issues.
Family Care
1. I do not have dependent care for my child(ren), elderly or disabled household members.
2. I have dependent care, but it is unreliable. I am often late or absent from work or school due to dependent care issues.
3. I have reliable dependent care, but no backup plan. I am sometimes late or absent from work or school due to dependent care issues.
4. I have reliable dependent care with backup, but my choices are limited due to my income. I am rarely late or absent from work or school due to dependent care issues.
5. I have reliable, affordable dependent care of my choice, with backup. I am never late or absent from work or school due to dependent care issues.
Parenting
1. I don't have the tools and support I need to feel like a good parent.
2. I have little tools and support to feel like a good parent.
3. I have some tools and support to feel like a good parent.
4. I have sufficient tools and support to feel like a good parent.
5. I have excellent tools and support to feel like a good parent.
Children's Education
1. My child is experiencing many challenges in school, and I have not planned for their educational future.
2. My child is experiencing some challenges in school, and I have thought about planning for their future.
3. My child is experiencing few challenges in school, and I have started a plan for their future.
4. My child is doing well in school, and I have planned and saved a little for their future.
5. My child is doing very well in school, and I have planned and saved a sufficient amount for their future.
Clothing & Grooming
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1. I do not have clothing items for work. I am not familiar with professional dress and grooming standards.
2. I have little clothing items for work. I am not very familiar with professional dress and grooming standards.
3. I have some clothing items for work. I am familiar with professional dress and grooming standards.
4. I have sufficient clothing items for work. I am very familiar with professional dress and grooming standards.
5. I have many clothing items for work. I am extremely familiar with professional dress and grooming standards.
Legal
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1. My legal issues always interfere with my choices.
2. My legal issues often interfere with my choices.
3. My legal issues sometimes interfere with my choices.
4. My legal issues rarely interfere with my choices.
5. My legal issues never interfere with my choices.
Safety
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1. I never feel safe in my environment.
2. I rarely feel safe in my environment.
3. I sometimes feel safe in my environment.
4. I usually feel safe in my environment.
5. I always feel safe in my environment.
Communication
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1. I don’t have access to a telephone or internet.
2. I rarely have access to a telephone or internet.
3. I sometimes have access to telephone or internet.
4. I usually have access to telephone or internet.
5. I always have access to telephone or internet.
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Health & Wellness
Please select the statement that best represents you in relation to the Life Domain.
Food, Nutrition, & Exercise
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1. I go to a food bank or soup kitchen to eat. My healthy options are very limited. I am not physically active at all.
2. I use SNAP to buy groceries. My healthy options are somewhat limited. I am not very physically active.
3. I buy groceries with my own income. I have healthy options available. I am somewhat physically active.
4. I buy groceries with my own income. I have healthy options very available. I am physically active.
5. I buy groceries with my own income. I always have healthy options available. I am very physically active.
Healthcare
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1. I don't have healthcare coverage. I depend on emergency care very often.
2. I have public healthcare coverage (MediCal, MediCare, etc.). I depend on urgent/emergency care fairly often.
3. I have basic healthcare coverage with high out-of-pocket costs. I sometimes depend on urgent/emergency care.
4. I have sufficient healthcare coverage. I almost never depend on urgent/emergency care.
5. I have high quality health coverage. I rarely depend on urgent/emergency care.
Alcohol, Drugs, or Tobacco
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1. Alcohol, drugs, or tobacco interrupts my daily activities very often.
2. Alcohol, drugs, or tobacco interrupts my daily activities fairly often.
3. Alcohol, drugs, or tobacco sometimes interrupts my daily activities.
4. Alcohol, drugs, or tobacco almost never interrupts my daily activities.
5. Alcohol, drugs, or tobacco never interrupts my daily activities.
Social Interaction
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1. I only leave my home for errands, appointments, and groceries.
2. I visit friends and/or family and talk with them on the phone.
3. Friends and/or family visit. I sometimes go out to eat, to church, to and participate in community activities.
4. Friends and/or family visit. I go out to eat, to church, and participate in community activities fairly often.
5. Friends and/or family visit. I go out to eat, to church, and participate in community activities very often.
Emotional Health
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1. Stress interrupts my daily activities very often.
2. Stress interrupts my daily activities fairly often.
3. Stress sometimes interrupts my daily activities.
4. Stress almost never interrupts my daily activities.
5. Stress never really interrupts my daily activities.
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Finished!
Now that we are finished with the assessment.
Please select the category(s) where you feel you need the most assistance.
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Workforce
Financial
Work Supports
Health & Wellness
Submit
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