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2017
AFS 401(k) Retirement Services, LLC
Financial Wellness Assessment

As we prepare for 2017, we are working hard to develop a customized financial program to meet your unique needs and those of your colleagues. As a valued participant, we deeply appreciate your feedback and insight in helping to build our 2017 financial wellness education program for your organization. 

Please take a few minutes to answer questions about the areas of financial wellness that would be most relevant to you for next year and beyond. Your feedback will be used to help us develop educational programs to meet your needs. Please know, all responses are confidential, and will only be used to provide a general picture of the community's financial status and needs.

All participants who complete the assessment by December 20th (12/20/2016) will be eligible to win one of three $75 Amazon gift cards, as part of our financial wellness drawing. Please complete your name and e-mail in the assessment in order to be entered into the drawing.*

Thank you again for your participation and your comments.
1.Name(Required.)
2.Email(Required.)
3.Organization(Required.)
4.Age
5.My gross annual household income is:
6.How many members are in your household?
7.I am married
8.I have MINOR children:
9.Please select the 3 most important priorities for you:
10.My biggest financial challenge is (select all that apply):
11.I spend less than I make each month:
12.I have emergency savings to cover unexpected expenses or to pay bills for at least 3 months if I lose my job:
13.I contribute to my retirement plan at work, such as a 401(k), 457, or 403(b) plan:
14.I know I'm on track to replace the recommended 80% of my income in retirement:
15.I have completed a risk tolerance questionnaire to determine my appetite for risk: 
16.I feel confident that my investments are allocated appropriately between stocks, bonds, and cash based on my risk tolerance and time horizon:
17.My retirement plan savings are invested in the following (select one):
18.I have made sure that my beneficiary designations on insurance policies and retirement plans are up to date:
19.I have a seperate savings account of other short-, mid-, and long-term goals
20.Please identify your savings priorities (with 1 being your highest priority and 5 being your lowest):
Priority
Amount Currently Saved
Monthly Savings (as % of monthly income)
Saving for retirement
Saving for emergencies
Saving for a house
Saving for higher education
Other
21.I'm comfortable with the amount of debt I have (not including my mortgage):
22.I own a home:
23.I have refinanced my home in the past 3 years:
24.I pay my bills on time each month:
25.I pay my bills in full each month:
26.I have credit card debt:
27.I regularly pay off my credit card balances in full:
28.I check my credit report on an annual basis:
29.I have student loan debt:
30.Please identify your top debt-related priorities (with 1 being your highest priority and 5 being your lowest priority):
Priority
Amount Outstanding
Interest Rate
Reducing credit card debt
Reducing student loan debt
Reducing other debt (auto, mortgage, personal, etc.)
Creating and maintaining a budget
Other
31.How do you prefer to receive financial advice? (check all that apply)
32.I would be interested in participating in wellness programs outside of the office during non-work hours.