Date
First Name
Last Name
Employee ID
Department
Job Title
Start Date
Contact Phone
Email Address
Our corporate wellness program offers a variety of financial planning assistance options. Please indicate your level of interest in the following programs and answer the related questions:
Highly Interested
Interested
Neutral
Not Interested
Specific Areas of Interest (Check all that apply):
Creating a personal budget
Debt consolidation strategies
Credit score improvement
Managing student loan debt
General debt reduction
What are your primary concerns regarding your current financial situation?
Highly Interested
Interested
Neutral
Not Interested
Specific Areas of Interest (Check all that apply):
Understanding company retirement plans (401(k), etc.)
Estimating retirement income needs
Investment strategies for retirement
Rollover options
Social Security planning
What is your current level of understanding of retirement planning?
Beginner
Intermediate
Advanced
What is your ideal retirement age?
Highly Interested
Interested
Neutral
Not Interested
Specific Areas of Interest (Check all that apply):
Investment diversification
Risk tolerance assessment
Understanding different investment vehicles (stocks, bonds, mutual funds, etc.)
Long term investment strategies
What is your risk tolerance?
Conservative
Moderate
Aggressive
Highly Interested
Interested
Neutral
Not Interested
Preferred Workshop Topics (Check all that apply):
Basic financial literacy
Investing for beginners
Estate planning basics
Tax planning strategies
Homeownership planning
Preferred Format:
In-person
Virtual
Recorded sessions
Highly Interested
Interested
Neutral
Not Interested
What are your primary goals for one-on-one counseling?
Preferred Meeting Times:
Please enter:
Description | Amount | ||
|---|---|---|---|
A | B | ||
1 | Annual Income (Gross): | ||
2 | Monthly Expenses (Estimated): | ||
3 | Outstanding Debt (Total): | $0.00 | |
4 |
| ||
5 |
| ||
6 |
| ||
7 |
| ||
8 | Current Savings/Investments (Total): | $0.00 | |
9 |
| ||
10 |
| ||
11 |
|
Do you currently have a budget?
Do you have an emergency fund?
If yes, how many months of expenses does it cover?
Do you have life insurance?
Do you have disability insurance?
What are your primary financial goals? (e.g., buying a home, paying off debt, saving for education, early retirement)?
Are there any significant life events or changes anticipated in the next 1-5 years? (e.g., marriage, children, home purchase, career change)?
Do you have any dependents?
If yes, how many?
Are you currently contributing to the company's retirement plan?
If yes, what percentage of your salary?
I understand that the information provided in this form will be kept confidential and used solely for the purpose of providing financial planning assistance through the corporate wellness program.
I agree to provide accurate and complete information to facilitate the planning process.
Employee Signature:
Thank you for participating in the Financial Planning Assistance Program!
Form Template Insight
Please remove this form template insight section before publishing.
Important Notes for Implementation:
This comprehensive form will help you gather the necessary information to provide personalized and effective financial planning assistance to your employees.
Let's break down the detailed insights into this Financial Planning Assistance for Corporate Wellness Programs - Employee Intake Form:
1. Purpose and Scope:
2. Key Sections and Their Significance:
Employee Information:
Program Selection and Preferences:
Current Financial Situation:
Personal Goals and Circumstances:
Additional Information/Comments:
Consent and Agreement:
3. Strategic Implications:
4. Best Practices:
In essence, this form is a powerful tool for companies to promote financial wellness among their employees. By gathering comprehensive data and understanding employee preferences, companies can create effective and impactful financial planning programs.
To configure an element, select it on the form.