Company Name
Company Address
Contact Person
Title
Phone Number
Email Address
Company Industry
Number of Employees Participating (Estimated)
Preferred Format for Debt Management Education
In-person workshops
Virtual webinars
On-demand video modules
Printed materials (e.g., guides, handouts)
Mobile app resources
Other (Please specify):
Preferred Duration of Sessions
30 minutes
1 hour
2 hours
Half-day workshop
Full-day workshop
Preferred Frequency of Sessions
One-time session
Weekly
Bi-weekly
Monthly
Quarterly
Target Audience
All employees
Entry-level employees
Mid-level managers
Senior executives
Specific departments (Please specify):
Please indicate the level of interest for each topic (1 = Not Interested, 5 = Very Interested)
Topic | Rating (1=Not Interested, 5=Very Interested) | ||
|---|---|---|---|
1 | Budgeting and Financial Planning | ||
2 | Understanding and Managing Debt | ||
3 | Credit Score Improvement | ||
4 | Debt Repayment Strategies | ||
5 | Student Loan Management | ||
6 | Mortgage and Housing Debt | ||
7 | Managing Card Debt | ||
8 | Bankruptcy and Debt Relief Options | ||
9 | Financial Wellness and Mental Health | ||
10 | Retirement Planning and Debt |
Language Preferences
English
Spanish
Other (Please specify):
Customization Needs
Include company-specific examples
Tailor content to employee demographics
Other (Please specify):
Employee Engagement Tools
Surveys and feedback forms
Interactive activities and quizzes
Gamification (e.g., rewards, challenges)
Other (Please specify):
Follow-Up Support
One-on-one financial coaching
Email newsletters
Access to online resources
Other (Please specify):
What are your primary goals for offering debt management education?
Improve employee financial literacy
Reduce employee stress related to debt
Increase employee productivity
Enhance employee retention
Other (Please specify):
How will you measure the success of the program?
Employee feedback surveys
Participation rates
Reduction in employee financial stress (e.g., self-reported)
Other (Please specify):
What is your budget for this program?
Under $1,000.00
$1,000.00–$5,000.00
$5,000.00–$10,000.00
$10,000.00+
Preferred Start Date
Preferred End Date
Please provide any additional information or special requests
By submitting this form, you authorize us to use the provided information to design a customized debt management education program for your organization.
Signature
Form Template Insight
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Below is a detailed breakdown of the Debt Management Education for Corporate Wellness Programs Client Intake Form. This analysis explains the purpose of each section, the rationale behind the questions, and how the information gathered can be used to design an effective and tailored debt management education program for corporate clients.
1. Corporate Client Information
This section collects basic details about the company and the primary contact person. It helps in understanding the client's organizational structure and size, which is crucial for tailoring the program to their specific needs.
2. Program Preferences
This section focuses on how the client envisions the program being delivered. It ensures the format, duration, and frequency align with the company’s culture and employee availability.
3. Debt Management Topics of Interest
This section identifies the specific areas of debt management that are most relevant to the client’s employees. It ensures the program addresses their most pressing financial concerns.
4. Additional Preferences
This section ensures the program is accessible, engaging, and aligned with the company’s culture.
5. Program Goals
This section clarifies the client’s objectives for offering the program, which helps in designing measurable outcomes.
6. Budget and Timeline
This section ensures the program is feasible and aligns with the client’s financial and scheduling constraints.
7. Additional Comments or Requests
This open-ended section allows the client to provide any extra information or special requests that haven’t been covered in the form. It ensures the program is as customized as possible.
8. Authorization and Submission
This final section formalizes the client’s agreement to proceed with the program design based on the provided information.
How This Form Benefits the Corporate Client
How This Form Benefits the Service Provider
In summary, this intake form is a comprehensive tool for gathering the information needed to design a debt management education program that is tailored, engaging, and impactful for corporate clients and their employees.