Free Financial Health Survey Template

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Free Financial Health Survey Template

Financial Health Survey

Thank you for participating in our Financial Health Survey. Your responses will help us understand the financial well-being of individuals in our region and shape policies to better support you. Your information is confidential, and your participation is voluntary.

I. Demographic Information

Age

  • 18-25

  • 26-35

  • 36-45

  • 46-55

  • 56 and above

Gender

  • Male

  • Female

  • Prefer not to say

Marital Status

  • Single

  • Married

  • Divorced

  • Widowed

Education Level

  • High School or Below

  • College/University

  • Postgraduate

Employment Status

  • Employed Full-Time

  • Employed Part-Time

  • Unemployed

  • Self-Employed

II. Income and Expenses

A. Household Income

Source

Monthly Amount ($)

Employment

[0]

Investments

[0]

Other

[0]

Total Income

[0]

B. Monthly Expenses

Expense

Monthly Amount ($)

Housing

[0]

Utilities

[0]

Food

[0]

Transportation

[0]

Entertainment

[0]

Total Expenses

[0]

C. Savings and Investments

Type

Presence

Savings Account

  • Yes

  • No

Investment Portfolio

  • Yes

  • No

III. Debt Profile

Type

Amount ($)

Mortgage

[0]

Auto Loans

[0]

Credit Cards

[0]

Student Loans

[0]

Total Debt

[0]

Monthly Debt Payments: $1,500

IV. Financial Goals and Planning

A. Short-Term Financial Goals

Goal

Target Amount ($)

Emergency Fund

[0]

Vacation

[0]

B. Long-Term Financial Goals

Goal

Target Amount ($)

Homeownership

[0]

Retirement

[0]

C. Retirement Planning

Goal

Target Amount ($)

Contributing to Retirement Accounts

[0]

Estimated Retirement Age

[0]

V. Financial Literacy

A. Basic Financial Knowledge:

1. Budgeting:

  • Beginner

  • Intermediate

  • Advanced

2. Understanding Interest Rates:

  • Beginner

  • Intermediate

  • Advanced

3. Investment Awareness:

  • Beginner

  • Intermediate

  • Advanced

B. Sources of Financial Information:

  • Financial News Websites

  • Books

  • Financial Advisors

  • Online Courses

VI. Financial Well-being Perceptions

A. Self-assessment of Financial Well-being:

  • Very Satisfied

  • Satisfied

  • Neutral

  • Dissatisfied

  • Very Dissatisfied

B. Factors Influencing Financial Satisfaction:

  • Job Security

  • Income Level

  • Budgeting Skills

VII. Emergency Preparedness

A. Emergency Savings:

Savings Goal

Current Progress ($)

Target Amount ($)

Short-Term Emergencies

[0]

[0]

Medical Expenses

[0]

[0]

VIII. Access to Financial Services

A. Banking Services Utilized:

  • Checking Account

  • Savings Account

  • Credit Card

B. Access to Credit:

  • Easily Accessible

  • Somewhat Accessible

  • Difficult to Access

  • Economic Confidence

C. Perceptions of Economic Conditions:

  • Positive

  • Neutral

  • Negative

D. Confidence in Job Security:

  • Very Confident

  • Confident

  • Neutral

  • Not Confident

  • Not at all Confident

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