Financial Planning Assessment Form

Please complete the form below.

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Directions: The statements below will help you to explore various aspects of your financial life. 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

1. I believe my life has purpose(Required)

2. I am very clear on my life aspirations(Required)

3. I have written goals to support my life aspirations(Required)

4. I have a detailed plan to accomplish my goals(Required)

5. I understand my unique skills and abilities(Required)

6. I feel good about my career/work path(Required)

7. I am doing what I love in life(Required)

8. I am clear about what I want to 'do' with the rest of my life(Required)

9. I have time to meditate(Required)

10. I have time to plan my life(Required)

11. Spirituality is important to me(Required)

12. I have a spiritual practice(Required)

13. My values match my financial behaviors(Required)

14. I feel comfortable with my health status(Required)

15. I exercise at least 3 times a week for 1/2 hour or more(Required)

16. I regularly participate in enjoyable activities/hobbies(Required)

17. The environment I live in nurtures me(Required)

18. The environment I work in nurtures me(Required)

19. I take regular vacations and play(Required)

20. I understand my future financial needs(Required)

21. I have an up to date retirement cash flow analysis(Required)

22. I have done a spending plan/budget for retirement(Required)

23. I am maximizing contributions to my retirement plans(Required)

24. I know about what my social security check will be/is(Required)

25. I know how much I earn every month from all sources(Required)

26. I medicate with work(Required)

CASH FLOW

Rate the Following from 1-5. (1 being not true at all, 3 being neutral, 5 being very true)-Cash Flow

27. I know how much and on what I spend money each month(Required)

28. I pay off my credit cards every month(Required)

29. I have no consumer debt(Required)

30. I will be debt free by the time I retire(Required)

31. I have a spending plan/budget(Required)

32. I pay my bills on time(Required)

33. I pay my taxes on time(Required)

34. I live on less than I earn(Required)

35. I rarely have an(Required)

36. I review and comparison shop my fixed expenses periodically(Required)

37. I am saving for other goals: cars, houses, business(Required)

38. I enjoy saving money for my goals(Required)

39. I know what I pay in state and federal income taxes(Required)

40. I medicate by spending money(Required)

INSURANCE & ASSET PROTECTION

Rate the Following from 1-5. (1 being not true at all, 3 being neutral, 5 being very true)-Insurance & Asset Protection

41. I have 6 to 12 months of emergency funds in a savings account(Required)

42. I have adequate life insurance (10 x's my salary)(Required)

43. My risk of income loss from disability is covered(Required)

44. I have adequate health insurance(Required)

45. My risk of loss from a negligent act is covered(Required)

46. I review and comparison shop my insurance periodically(Required)

47. My portfolio's investment risk is appropriate for me(Required)

48. I have a pre/post-nuptial agreement(Required)

49. I have considered a domestic asset protection trust(Required)

50. My risk of out living my income is covered(Required)

51. My other special risks are recognized and covered(Required)

52. I have no partnerships or sole proprietorships (1040-Schedule C)(Required)

53. I understand the basics of using trusts, corporations, and LLC's(Required)

54. Trusts, Corps, LLC's are in place to hold and protect my assets(Required)

LEGACY INTENTION

Rate the Following from 1-5. (1 being not true at all, 3 being neutral, 5 being very true)-Legacy Intention

55. My beneficiary designations are current(Required)

56. I have a will or a living trust(Required)

57. I know exactly where my will/trust, POA's, etc. are stored(Required)

58. I have a plan for incapacity (durable health/financial POAs)(Required)

59. I have a living will (resuscitation and artificial life extension)(Required)

60. I am at peace with my estate plan(Required)

61. My living trusts are funded and assets re-titled(Required)

62. I have an ethical will (memoir of beliefs, values, remembrances)(Required)

63. I have executed a letter of instruction to my family(Required)

64. I have discussed an assisted living plan with my family(Required)

65. I am satisfied with my current level of giving(Required)

66. I am satisfied with the level of charitable giving in my will/trust(Required)

67. I have a business succession plan in place(Required)

68. I have created a written funeral and burial plan(Required)

69. I have discussed my legacy intentions with family(Required)

INVESTMENT STRATEGY

Rate the Following from 1-5. (1 being not true at all, 3 being neutral, 5 being very true)-Investment Strategy

70. I have a written Investment Policy Statement(Required)

71. I look at my investment balances no more than monthly(Required)

72. My investment allocation is appropriate to my goals(Required)

73. I have 5 or more asset classes in my portfolio(Required)

74. My investment returns are average or better(Required)

75. I know the difference between dividend, interest, and total return(Required)

76. I know the difference between bonds, stocks, and mutual funds(Required)

77. I understand the concept of risk and return(Required)

78. I can accept the consequences of high risks(Required)

79. I know my net worth(Required)

80. I understand capitalism and how supply and demand works(Required)

FINANCIAL SUPPORT

Rate the Following from 1-5. (1 being not true at all, 3 being neutral, 5 being very true-Financial Support

81. I review and update my estate plan documents every 4 years(Required)

82. I review my plans for creating financial independence annually(Required)

83. I consult with a tax advisor at least annually(Required)

84. I update my spending plan at least annually(Required)

85. I share my financial reports regularly with those I trust(Required)

86. I update my financial statement at least annually(Required)

87. I review all my insurance coverage every two years(Required)

88. I review my asset allocation and investments at least annually(Required)

89. I am aware of incompletions and am completing them(Required)

90. I have an emotional and physical wellness plan(Required)

91. I get all the recommended physical check ups(Required)

92. I have a financial mentor(Required)

93. I have a life/financial coach(Required)

94. I have a therapist(Required)

95. I have an investment advisor(Required)

96. I have a financial planner(Required)

MONEY RELATIONSHIP

Rate the Following from 1-5. (1 being not true at all, 3 being neutral, 5 being very true)-Money Relationship

97. I rarely buy things in an attempt to make me feel better(Required)

98. I often think about money, retirement and my financial future(Required)

99. I don't feel fear when I look at my financial reports(Required)

100. I feel good about how I interact with my family around money(Required)

101. I function well around money(Required)

102. I am proud of my financial situation(Required)

103. I don't have any unfinished financial tasks or obligations(Required)

104. I have looked at my financial past and understand how it is affecting my present relationship with money(Required)

105. Financial issues do not confuse or depress me(Required)

106. My partner and I don't fight about money(Required)

107. My financial behaviors are consistent with my values and goals(Required)

108. I don't feel guilt or shame about my past financial behaviors(Required)

109. I have no problems sticking to a budget/spending plan(Required)

110. I have clear financial goals for the future(Required)

111. I am taking the steps necessary to meet my financial goals(Required)

112. I would be OK showing friends how I actually spend my money(Required)

113. I am OK with others asking questions about my income(Required)

114. I am OK with receiving money/gifts from others(Required)

115. I am OK earning more/having more than others(Required)

116. I am/would be OK if my spouse/partner earns more than I(Required)

117. I treat every dollar the same, whether its salary or a gift(Required)

118. When it comes to investing and money, I am confident(Required)

119. The price of an item I purchased yesterday has little relevance today(Required)

120. A loss hurts me more than an equal gain pleases me(Required)

121. In times of financial crisis I listen to the media less than normal(Required)

On a scale from 1-10 (10 being the highest), select your level of comfort for each topic.

Life Planning(Required)

Cash Flow(Required)

Insurance & Asset Protection(Required)

Legacy Intention(Required)

Investment Strategy(Required)

Financial Support(Required)

Money Relationship(Required)

Rank 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 Planning(Required)