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