Community Survey Today's Date(Required) MM slash DD slash YYYY Name(Required) First Last Email(Required) Phone Number(Required)How would you describe your current financial situation? (check all that apply)(Required) Lack of Income / Job Loss Unexpected Expenses Too Much Debt Need for Financial Independence Overspending or Lack of Budget Employed, but not reaching my financial goals Employed and don't currently have any financial goals How would you describe your financial literacy?(Required) Just getting started I have a basic understanding of managing my finances I am very knowledgeable What type of financial service(s) are you most interested in? (check all that apply)(Required) Budgeting and Personal Finance Planning Tax Planning and Filing Assistance Retirement Planning and 401(k) Guidance Debt Management and Credit Counseling Home Buying and Mortgage Advice Business Financial Services Student Loan Repayment Assistance Insurance Planning (Health, Life, Auto, etc.) Estate Planning and Trust Services Investment Advice and Wealth Management Other If "Other," please specify:(Required)What are your current financial goals? (check all that apply)(Required) Saving for a Major Purchase (Home, Car, etc.) Building an Emergency Fund Reducing Debt Growing Investments or Savings Preparing for Retirement Tax Optimization Building Credit Starting or Growing a Business Other If "Other," please specify:What are some barriers to you reaching the goals selected above? (check all that apply)(Required) Low or No Emergency Savings Borrowing / Spending in Excess Limited or No Access to Traditional Banking Services I Don't Really Understand How Banking / Credit and Money Works Low Credit Score or Lack of Credit History Would you be interested in receiving free financial coaching to help you set and meet your financial goals?(Required) Yes No What is your preferred method of contact?(Required) Text Call Email What is your preferred setting for receiving financial advice?(Required) In-Person Meetings Virtual Consultations (via Zoom or other platforms) Email or Online Messaging Phone Calls Hybrid (both virtual and in-person coaching) Which day(s) of the week work best for you? (check all that apply)(Required) Monday Tuesday Wednesday Thursday Friday Saturday What time(s) work best for you? (check all that apply)(Required) Mornings Afternoons Evenings
