Corporate Wellness Programs: Financial Planning Assistance Client Intake Form

I. Client Information

Company Name

Contact Person

Job Title


Email Address

Phone Number


Company Size

Industry

Location(s) of Operations

City

State

Zip Code

II. Program Preferences

Please indicate your level of interest in the following financial wellness programs (1 = Not Interested, 5 = Very Interested):

Program

Rating

(1 = Not Interested, 5 = Very Interested)

1
Budgeting and Financial Literacy Workshops
2
Debt Management and Reduction Strategies
3
Retirement Planning and Savings Programs
4
Investment Education and Guidance
5
Tax Planning and Optimization
6
Emergency Savings and Financial Safety Nets
7
Student Loan Repayment Assistance Programs
8
Homeownership and Mortgage Planning
9
Insurance Planning (Life, Health, Disability)
10
Estate Planning and Wealth Transfer Strategies
11
Financial Coaching and One-on-One Counseling
12
Employee Discount Programs (e.g., gym, retail)
13
Financial Wellness Apps and Tools

III. Employee Demographics and Needs

What percentage (%) of your employees are:

Under 30:

30–50:


Over 50:

What are the most common financial challenges your employees face?

How do employees currently access financial wellness resources?

IV. Program Delivery Preferences

Preferred Format for Financial Wellness Programs:

Preferred Frequency of Programs:

Preferred Time for Programs:

V. Budget and Resources

What is your budget for financial wellness programs?


Do you have internal resources to support program implementation?

Are you open to partnering with external financial wellness providers?

VI. Goals and Success Metrics

What are your primary goals for implementing a financial wellness program?

How will you measure the success of the program?

VII. Additional Information

Are there any specific financial wellness topics or concerns you would like addressed?

Do you have any existing wellness programs?

Any other comments or requests?

VIII. Authorization and Submission

By submitting this form, you authorize us to use the provided information to design and propose a tailored financial wellness program for your organization.


Signature:

Form Template Insight

Please remove this form template insight section before publishing.


The Corporate Wellness Programs: Financial Planning Assistance Client Intake Form is a comprehensive tool designed to gather critical information about a company’s needs, preferences, and goals for implementing financial wellness programs. Below is a detailed breakdown of the form’s sections, their purpose, and the insights they provide:


1. Client Information

This section collects basic details about the company and its primary contact person.


Purpose: To identify the client and establish communication channels.


Insights:

  • Company size and industry help tailor programs to the specific workforce demographics and challenges.
  • Location(s) of operations may influence program delivery (e.g., in-person vs. virtual).

2. Program Preferences

This section uses a rating system to gauge the client’s interest in various financial wellness programs.


Purpose: To understand which programs align with the client’s priorities.


Insights:

  • High interest in budgeting and financial literacy workshops may indicate employees need foundational financial skills.
  • Interest in debt management or student loan repayment assistance suggests employees may be struggling with debt.
  • Interest in retirement planning or investment education may reflect a focus on long-term financial security.
  • Low interest in certain programs helps avoid unnecessary resource allocation.

3. Employee Demographics and Needs

This section focuses on the workforce’s characteristics and financial challenges.


Purpose: To tailor programs to the specific needs of employees.


Insights:

  • Age demographics (e.g., under 30 vs. over 50) help determine program relevance (e.g., student loans for younger employees, retirement planning for older employees).
  • Common financial challenges (e.g., debt, retirement savings) highlight areas where employees need the most support.
  • Current access to financial wellness resources reveals gaps in existing offerings.

4. Program Delivery Preferences

This section explores how the client prefers to deliver financial wellness programs.


Purpose: To ensure the program format aligns with the company’s operational structure and employee preferences.


Insights:

  • Preference for in-person workshops may indicate a desire for interactive, hands-on learning.
  • Preference for virtual webinars or on-demand videos suggests flexibility is a priority.
  • Preferred timing (e.g., during work hours vs. after hours) helps maximize participation.

5. Budget and Resources

This section assesses the client’s financial commitment and available resources.


Purpose: To design a program that fits within the client’s budget and resource constraints.


Insights:

  • Budget range helps determine the scope of the program (e.g., basic workshops vs. comprehensive coaching).
  • Availability of internal resources (e.g., HR support) influences the level of external assistance required.
  • Openness to external partnerships indicates willingness to explore third-party solutions.

6. Goals and Success Metrics

This section identifies the client’s objectives and how they plan to measure success.


Purpose: To align the program with the client’s desired outcomes.


Insights:

  • Goals such as reducing employee financial stress or increasing retirement savings participation guide program design.
  • Success metrics (e.g., employee feedback, participation rates) help evaluate program effectiveness and ROI.

7. Additional Information

This section allows the client to provide any extra details or requests.


Purpose: To capture unique needs or concerns not covered in previous sections.


Insights:

  • Specific topics or concerns (e.g., estate planning, tax optimization) highlight niche areas for program customization.
  • Existing wellness programs provide context for integrating financial wellness into broader initiatives.

8. Authorization and Submission

This section formalizes the client’s consent to use the provided information.


Purpose: To ensure compliance and establish a formal agreement.


Insights:

  • The signature confirms the client’s commitment to moving forward with program design.

Key Insights from the Form

  1. Customization: The form ensures programs are tailored to the company’s workforce demographics, financial challenges, and delivery preferences.
  2. Resource Allocation: By understanding the budget and internal resources, the program can be designed to maximize impact without overextending the client.
  3. Goal Alignment: The form ensures the program aligns with the client’s objectives, whether it’s improving financial literacy, reducing stress, or boosting retention.
  4. Employee-Centric Approach: By focusing on employee needs and preferences, the program is more likely to achieve high participation and positive outcomes.
  5. Measurable Success: Clear success metrics enable ongoing evaluation and improvement of the program.

How to Use the Insights

  • Program Design: Use the client’s preferences and employee demographics to create a program that addresses specific needs (e.g., debt management for younger employees, retirement planning for older employees).
  • Delivery Strategy: Choose formats (e.g., virtual, in-person) and timing that maximize employee engagement.
  • Budget Planning: Allocate resources efficiently based on the client’s budget and available internal support.
  • Evaluation: Use the success metrics to track progress and demonstrate the program’s value to the client.

This form is a powerful tool for designing effective, tailored financial wellness programs that meet the unique needs of each client and their employees.


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