Financial Planning Assessment Form Please complete the form below. Financial Planning Assessment Date* Your Name*FirstLastDirections:The statements below will help you to explore various aspects of your financiallife. Select and record your level of satisfaction for each statement.LIFE PLANNING Rate the Following from 1-5. (1 being not true at all, 3 being neutral, 5 being very true)-Life Planning*123451. I believe my life has purpose2. I am very clear on my life aspirations 3. I have written goals to support my life aspirations4. I have a detailed plan to accomplish my goals5. I understand my unique skills and abilities6. I feel good about my career/work path7. I am doing what I love in life8. I am clear about what I want to 'do' with the rest of my life9. I have time to meditate10. I have time to plan my life11. Spirituality is important to me12. I have a spiritual practice13. My values match my financial behaviors14. I feel comfortable with my health status15. I exercise at least 3 times a week for 1/2 hour or more16. I regularly participate in enjoyable activities/hobbies17. The environment I live in nurtures me18. The environment I work in nurtures me19. I take regular vacations and play20. I understand my future financial needs21. I have an up to date retirement cash flow analysis22. I have done a spending plan/budget for retirement23. I am maximizing contributions to my retirement plans24. I know about what my social security check will be/is25. I know how much I earn every month from all sources26. I medicate with workCASH FLOW Rate the Following from 1-5. (1 being not true at all, 3 being neutral, 5 being very true)-Cash Flow*1234527. I know how much and on what I spend money each month28. I pay off my credit cards every month29. I have no consumer debt30. I will be debt free by the time I retire31. I have a spending plan/budget32. I pay my bills on time33. I pay my taxes on time34. I live on less than I earn35. I rarely have an 36. I review and comparison shop my fixed expenses periodically37. I am saving for other goals: cars, houses, business38. I enjoy saving money for my goals39. I know what I pay in state and federal income taxes40. I medicate by spending moneyINSURANCE & ASSET PROTECTION Rate the Following from 1-5. (1 being not true at all, 3 being neutral, 5 being very true)-Insurance & Asset Protection*1234541. I have 6 to 12 months of emergency funds in a savings account42. I have adequate life insurance (10 x's my salary)43. My risk of income loss from disability is covered44. I have adequate health insurance45. My risk of loss from a negligent act is covered46. I review and comparison shop my insurance periodically47. My portfolio's investment risk is appropriate for me48. I have a pre/post-nuptial agreement49. I have considered a domestic asset protection trust50. My risk of out living my income is covered51. My other special risks are recognized and covered52. I have no partnerships or sole proprietorships (1040-Schedule C)53. I understand the basics of using trusts, corporations, and LLC's54. Trusts, Corps, LLC's are in place to hold and protect my assetsLEGACY INTENTION Rate the Following from 1-5. (1 being not true at all, 3 being neutral, 5 being very true)-Legacy Intention*1234555. My beneficiary designations are current56. I have a will or a living trust57. I know exactly where my will/trust, POA's, etc. are stored58. I have a plan for incapacity (durable health/financial POAs)59. I have a living will (resuscitation and artificial life extension)60. I am at peace with my estate plan61. My living trusts are funded and assets re-titled62. I have an ethical will (memoir of beliefs, values, remembrances)63. I have executed a letter of instruction to my family64. I have discussed an assisted living plan with my family65. I am satisfied with my current level of giving66. I am satisfied with the level of charitable giving in my will/trust67. I have a business succession plan in place68. I have created a written funeral and burial plan69. I have discussed my legacy intentions with familyINVESTMENT STRATEGY Rate the Following from 1-5. (1 being not true at all, 3 being neutral, 5 being very true)-Investment Strategy*1234570. I have a written Investment Policy Statement71. I look at my investment balances no more than monthly72. My investment allocation is appropriate to my goals73. I have 5 or more asset classes in my portfolio74. My investment returns are average or better75. I know the difference between dividend, interest, and total return76. I know the difference between bonds, stocks, and mutual funds77. I understand the concept of risk and return78. I can accept the consequences of high risks79. I know my net worth80. I understand capitalism and how supply and demand worksFINANCIAL SUPPORT Rate the Following from 1-5. (1 being not true at all, 3 being neutral, 5 being very true-Financial Support*1234581. I review and update my estate plan documents every 4 years82. I review my plans for creating financial independence annually83. I consult with a tax advisor at least annually84. I update my spending plan at least annually85. I share my financial reports regularly with those I trust86. I update my financial statement at least annually87. I review all my insurance coverage every two years88. I review my asset allocation and investments at least annually89. I am aware of incompletions and am completing them90. I have an emotional and physical wellness plan91. I get all the recommended physical check ups92. I have a financial mentor93. I have a life/financial coach94. I have a therapist95. I have an investment advisor96. I have a financial plannerMONEY RELATIONSHIP Rate the Following from 1-5. (1 being not true at all, 3 being neutral, 5 being very true)-Money Relationship*1234597. I rarely buy things in an attempt to make me feel better98. I often think about money, retirement and my financial future99. I don't feel fear when I look at my financial reports100. I feel good about how I interact with my family around money101. I function well around money102. I am proud of my financial situation103. I don't have any unfinished financial tasks or obligations104. I have looked at my financial past and understand how it is affecting my present relationship with money105. Financial issues do not confuse or depress me106. My partner and I don't fight about money107. My financial behaviors are consistent with my values and goals108. I don't feel guilt or shame about my past financial behaviors109. I have no problems sticking to a budget/spending plan110. I have clear financial goals for the future111. I am taking the steps necessary to meet my financial goals112. I would be OK showing friends how I actually spend my money113. I am OK with others asking questions about my income114. I am OK with receiving money/gifts from others115. I am OK earning more/having more than others116. I am/would be OK if my spouse/partner earns more than I117. I treat every dollar the same, whether its salary or a gift118. When it comes to investing and money, I am confident119. The price of an item I purchased yesterday has little relevance today120. A loss hurts me more than an equal gain pleases me121. In times of financial crisis I listen to the media less than normal On a scale from 1-10 (10 being the highest), select your level of comfort for each topic.*12345678910Life PlanningCash FlowInsurance & Asset ProtectionLegacy IntentionInvestment StrategyFinancial SupportMoney RelationshipRank the topics in order of priority to you.("1" being the highest priority, and end with "7" being the lowest) Rank the topics in order of priority to you. ("1" being the highest priority, and end with "7" being the lowest).*Life PlanningCash FlowInsurance & Asset ProtectionLegacy IntentionInvestment StrategyFinancial SupportMoney RelationshipTotal: 0/28SubmitReset
