Performance Assessment

Please take a few minutes to answer these few questions so we can better assist you!

Your Name (required)

Your Email (required)

1) Indicate short term (S), Medium (M) and Long Term (L) Financial Goals.

Short term (S) Medium term (M) Long Term (L)

Select a maximum of two goals for the term you selected.

Improve or fix my creditBecome a better saverLive on a budgetStart or Manage a Small Business

Buy or refinance homeBuy or refinance carOpen a savings, checking investment account

2) Rate your current understanding of financial terms--rate on a scale from 1-5

(1) do not know, 2) know some what 3)limited 4) good 5) very well

3) Is your monthly income greater than your monthly expenses?
Yes or No
YesNo

4) Do you currently have life insurance coverage for you, family, or business?
Yes or No
YesNo

Any Additional Comments (160 character limit)

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