1. How satisfied you are with your present financial situation. The “1” represents complete dissatisfaction. The “10” represents complete satisfaction. The more dissatisfied you are, the lower the number you should choose. The more satisfied you are, the higher the number you should choose.
   

   1	2	3	4	5	6	7	8	9	10
   Dissatisfied					Satisfied

   
   
   
2. How do you feel about your current financial situation?
   

   1	2	3	4	5	6	7	8	9	10
   Feel Overwhelmed		Sometimes Feel Worried			Not Worried			Feel Comfortable

   
   
   
3. How often do you worry about being able to meet normal monthly living expenses?
   

   1	2	3	4	5	6	7	8	9	10
   Worry All the Time		Sometimes Worry			Rarely Worry			Never Worry

   
   
   
4. What do you feel is the level of your financial stress today?
   

   1	2	3	4	5	6	7	8	9	10
   Overwhelming Stress		High Stress			Low Stress			No Stress at All

   
   
   
5. How stressed do you feel about your personal finances in general?
   

   1	2	3	4	5	6	7	8	9	10
   Overwhelming Stress		High Stress			Low Stress			No Stress at All

   
   
   
6. And, how confident are you that you could find the money to pay for a financial emergency that costs about $1,000?
   

   1	2	3	4	5	6	7	8	9	10
   No Confidence		Little Confidence			Some Confidence			High Confidence

   
   
   
7. How often does this happen to you? You want to go out to eat, go to a movie or do something else and don’t go because you can’t afford to?
   

   1	2	3	4	5	6	7	8	9	10
   All the Time		Sometimes			Rarely			Never

   
   
   
8. How frequently do you find yourself just getting by financially and living paycheck to paycheck?
   

   1	2	3	4	5	6	7	8	9	10
   All the Time		Sometimes			Rarely			Never

Tell us about yourself: