Community Financial Survey

Community Financial Survey
Name*

First NameLast Name
Gender*

MaleFemalePrefer not to say
Your Age Group:*

under 2525 - 4040 - 6060+
Marital Status:*

SingleMarried with young kidsMarried with adult kidsSingle Parent with young kidsSingle Parent with adult kids
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
1. Employment Status:*

Employed full-timeEmployed part-timeSelf-employedRetired / UnemployedStudent
2. Are you concerned about not having enough protection in the case of disability, long-term illness or even death?*

YesNo
3. Do you feel that financial terms such as inflation and tax credits are difficult to understand?*

YesNo
4. Do you currently have any employer sponsored retirement accounts (401k, 403b, TSA, TSP, 457, etc.)?*

Yes, with my current employerYes, with my current employer and previous jobYes, with my previous employer, but not with my current jobNo, but I plan to startNo, and I’m not sure how to begin
5. Which of the following do you currently have? (Select all that apply)*

Savings accountInvestment account (stocks, mutual funds, crypto, etc.)Retirement accounts like, IRA, ROTH, SEP IRA, etc.Real Estate InvestmentBondAnnuities
6. How would you describe your investment risk tolerance?*

LowModerateHigh
7. What types of debt do you currently have? (Select all that apply)*

Credit cardsMortgageStudent loansPersonal loansCar LoansI am debt-free
8. What type of life insurance do you have?*

Term LifeWhole LifeVariable LifeIndexed Universal Life with living benefitsNone
9. If you were to choose, what would you rather have?*

Better rate of return for your moneyBetter safety for your moneyBoth
10. Do you have a long-term care or disability insurance?*

Yes, bothOnly disability insuranceOnly long-term care insuranceNo, I don’t have either
11. Do you believe the average American family is struggling financially and needs better education?*

Yes, absolutelySomewhatNot reallyNo, most are doing fine
12. Would you be interested in learning how money works and strategies to build a stronger financial future?*

Yes, I’m eager to learnMaybe, if it’s easy to understandNot at this timeI already have a plan in place
13. What financial topic(s) do you feel you need the most help with?*

College planning for my kidsRetirement planningLife insurance to protect my loved onesLong-term care planningEstate planningMedicare plans 65+Business retirement planningTax strategies and mitigation
14. Are you satisfied with your investment performance?*

YesNoI need a professional to help me earn a better return
15. Would you like to learn more about the tax-free investment strategies?*

YesNo
16. Who manages your investments accounts?*

SelfAdvisorEmployer-sponsored planNo-one
17. Do you have a will, trust, or estate plan in place?*

YesNoI would like to get one
18. On a scale of 1–10, how confident are you in your current financial situation?*
19. Are you concerned about the future of your job or career?*

YesNo
20. Are you open to exploring a new career opportunity?*

Yes, I'm actively lookingYes, I'm open to new opportunitiesNo, I'm not looking right now
Please provide the name or phone number of the person who referred you to this community survey*
Thank you for Participating!
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