Financial Planning Assistance for Corporate Wellness Programs - Employee Intake Form

Date

Employee Information

First Name

Last Name

Employee ID

Department

Job Title

Start Date

Contact Phone

Email Address

Program Selection and Preferences

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:

1. Budgeting and Debt Management:

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?

2. Retirement Planning:

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?

3 Investment Planning:

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

4. Financial Education Workshops/Seminars:

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

5. One-on-One Financial Counseling:

Highly Interested

Interested

Neutral

Not Interested

What are your primary goals for one-on-one counseling?

Preferred Meeting Times:

Current Financial Situation

Annual Income (Gross):

Monthly Expenses (Estimated):

Outstanding Debt (Total):

$0.00
  • Card Debt:
  • Student Loan Debt:
  • Mortgage/Rent:
  • Other Debt:

Current Savings/Investments (Total):

$0.00
  • Savings Accounts:
  • Retirement Accounts:
  • Investment Accounts:

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?

Personal Goals and Circumstances

What are your primary financial goals?

Buying a home

Paying off debt

Saving for education

Early retirement

Other:

Are there any significant life events or changes anticipated in the next 1-5 years?

Marriage

Children

Home purchase

Career change

Other:

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?

Additional Information/Comments

Consent and Agreement

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:

  • Confidentiality: Emphasize the confidentiality of the information collected.
  • Data Security: Ensure secure storage of employee data.
  • Regular Review: Review and update the form periodically to reflect changes in the program and employee needs.
  • Accessibility: Make the form easily accessible in digital and physical formats.
  • Follow-Up: Develop a process for following up with employees after they submit the form.

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:

  • Holistic Financial Wellness: The form aims to capture a comprehensive picture of an employee's financial situation, going beyond just retirement planning. It covers budgeting, debt management, investments, and general financial literacy.
  • Program Tailoring: The form is designed to help the company understand employee preferences and tailor the wellness program to meet their specific needs.
  • Confidentiality and Trust: Emphasizes confidentiality to encourage employees to be open and honest about their financial situations. This builds trust and encourages participation.
  • Internal Focus: It's specifically designed for internal employees, streamlining the process and leveraging existing employee data (like employee ID, department, etc.).

2. Key Sections and Their Significance:


Employee Information:

  • This section ensures accurate identification and communication with the employee.
  • Department and job title can provide insights into potential financial needs based on industry or role.

Program Selection and Preferences:

  • Interest Levels: Gauges employee interest in various financial planning services, allowing for resource allocation.
  • Specific Areas of Interest: Pinpoints precise areas where employees need help (e.g., student loan debt, investment diversification).
  • Open-Ended Questions: Provides qualitative data about employee concerns and goals, which is crucial for personalized planning.
  • Format Preferences: Allows the company to deliver educational content in the most effective way (in-person, virtual, recorded).
  • One-on-One Counseling: This section is vital for employees who seek personalized help. It allows for scheduling and goal setting.

Current Financial Situation:

  • Quantitative Data: Provides a snapshot of the employee's financial health, including income, expenses, debt, and savings.
  • Key Metrics: Gathers essential metrics for financial planning, such as debt-to-income ratio, savings rate, and emergency fund status.
  • Insurance Coverage: Inquires about life and disability insurance, which are crucial for financial protection.

Personal Goals and Circumstances:

  • Qualitative Goals: Uncovers the employee's long-term financial aspirations (e.g., buying a home, early retirement).
  • Life Events: Identifies potential financial challenges or opportunities arising from life changes.
  • Dependents: Accounts for the financial responsibilities of caring for others.
  • Company Retirement Plan Participation: Determines the employee's engagement with existing company benefits.

Additional Information/Comments:

  • Provides a space for employees to share any relevant information not covered in the form.

Consent and Agreement:

  • Formalizes the employee's consent to participate in the program and share their information.

3. Strategic Implications:

  • Data-Driven Decision Making: The data collected can be analyzed to identify trends and patterns, informing the design and delivery of the wellness program.
  • Personalized Support: The form enables financial planners to provide tailored advice and guidance based on individual needs.
  • Improved Employee Engagement: By addressing employees' financial concerns, the company can enhance employee morale, productivity, and retention.
  • Risk Management: Identifying employees with financial vulnerabilities allows the company to offer proactive support and potentially mitigate risks.
  • Program Evaluation: The data can be used to track the effectiveness of the wellness program and make adjustments as needed.

4. Best Practices:

  • Clear and Concise Language: Use simple language that is easy for all employees to understand.
  • User-Friendly Design: Ensure the form is visually appealing and easy to navigate.
  • Data Security: Implement robust security measures to protect employee data.
  • Regular Updates: Review and update the form periodically to reflect changes in the program and employee needs.
  • Accessibility: Make the form available in multiple formats (digital, paper) to accommodate different employee preferences.
  • Provide educational material: Some of the terms used in the form may be confusing for some employees. Providing a glossary of terms, and links to educational material can help improve the quality of the data received.

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.

To add a new question or element, click the Question & Element button in the vertical toolbar on the left.