First Name
Last Name
Employee ID
Department
Job Title
Start Date
Phone Number
Email Address
Please indicate your primary financial goals (check all that apply):
Budgeting and expense management
Debt reduction and management
Saving for emergencies
Retirement planning
Investment education and planning
Tax planning and optimization
Homeownership planning (e.g., saving for a down payment)
Education funding (e.g., for self or dependents)
Estate planning (e.g., wills, trusts)
Other (please specify):
Please select the types of financial assistance programs you are interested in:
Financial Education Workshops
Budgeting Basics
Debt Management Strategies
Retirement Planning 101
Investing for Beginners
Tax Planning Tips
Homeownership Preparation
Estate Planning Essentials
Other (please specify):
One-on-One Financial Coaching
Personalized budgeting assistance
Debt reduction plan creation
Retirement savings strategy
Investment portfolio review
Tax optimization consultation
Other (please specify):
Online Financial Tools and Resources
Access to budgeting apps (e.g., YNAB, Mint)
Retirement calculators
Debt payoff calculators
Investment simulators
Financial literacy courses (online)
Other (please specify):
Employer-Sponsored Financial Benefits
401(k) or retirement plan optimization
Health Savings Account (HSA) education
Employee stock purchase plan (ESPP) guidance
Student loan repayment assistance
Financial wellness stipends or bonuses
Other (please specify):
Additional Support Services
Credit counseling services
Legal assistance for financial matters
Mental health support for financial stress
Peer financial support groups
Other (please specify):
How do you prefer to receive financial wellness support?
In-person workshops
Virtual webinars
One-on-one sessions (in-person or virtual)
Self-paced online courses
Mobile apps or digital tools
Printed resources (e.g., guides, brochures)
Other (please specify):
How often would you like to participate in financial wellness programs?
Weekly
Bi-weekly
Monthly
Quarterly
As needed
What time of day works best for you to attend financial wellness sessions?
Morning (before work)
Lunch break
After work hours
Weekends
Flexible (anytime)
What is your current level of financial knowledge?
Beginner (just starting to learn)
Intermediate (some knowledge, but want to improve)
Advanced (confident in managing finances, but seeking optimization)
Do you have any specific financial concerns or challenges?
High levels of debt
Difficulty saving money
Lack of retirement savings
Confusion about investments
Stress related to financial decisions
Other (please specify):
I understand that the information provided in this form will be kept confidential and used solely for the purpose of tailoring financial wellness programs to my needs.
I consent to participate in the financial wellness programs offered by my employer.
Employee Signature:
Please use the space below to share any additional comments, questions, or specific requests regarding financial wellness programs:
Form Template Insight
Please remove this form template insight section before publishing.
Below is a detailed breakdown of the Financial Planning Assistance for Corporate Wellness Programs - Internal Employee Client Intake Form. This analysis explains the purpose of each section, the rationale behind the questions, and how the form can be used to design effective financial wellness programs.
1. Employee Information
Purpose:
Key Insights:
2. Section 1: Financial Wellness Goals
Purpose:
Key Insights:
3. Section 2: Preferred Financial Assistance Programs
Purpose:
Key Insights:
4. Section 3: Employee Preferences
Purpose:
Key Insights:
5. Section 4: Confidentiality and Consent
Purpose:
Key Insights:
6. Section 5: Additional Comments or Requests
Purpose:
Key Insights:
How This Form Benefits the Employer and Employees
For Employers:
For Employees:
Implementation Tips for Employers
This form is a powerful tool for creating a financially healthy workforce. By understanding employee needs and preferences, employers can design programs that not only improve financial literacy but also foster loyalty, reduce stress, and enhance overall productivity.