Pre-Workshop Survey: Financial Literacy Workshop

Email *

First Name

Last Name

Phone *

City

State

By checking this box, I consent to receive non-marketing and promotional calls and/or text messages from [BUSINESS NAME]. I understand calls may be automated, pre-recorded, or use an AI voice. I can opt out at any time by replying STOP or asking not to be contacted. Message frequency varies, message & data rates may apply. Text HELP for assistance, reply STOP to opt out.

Financial Knowledge and Confidence

1 = Strongly Disagree | 2 = Disagree | 3 = Neutral | 4 = Agree | 5 = Strongly Agree

I feel confident in my ability to create and follow a personal budget. *

Strongly DisagreeStrongly Agree

I understand how to prioritize expenses such as rent and utilities. *

Strongly DisagreeStrongly Agree

I am familiar with strategies to manage unexpected financial emergencies. *

Strongly DisagreeStrongly Agree

I know how to track my income and expenses effectively. *

Strongly DisagreeStrongly Agree

I feel knowledgeable about financial assistance programs for mortgage and utilities. *

Strongly DisagreeStrongly Agree

Current Financial Habits

Instructions: Please rate each statement below on a scale of 1 to 5, where:
1 = Strongly Disagree | 2 = Disagree | 3 = Neutral | 4 = Agree | 5 = Strongly Agree

I regularly set financial goals for myself. *

Strongly DisagreeStrongly Agree

I keep track of my monthly income and expenses. *

Strongly DisagreeStrongly Agree

I actively look for ways to save money on regular expenses. *

Strongly DisagreeStrongly Agree

I pay my rent and utility bills on time each month. *

Strongly DisagreeStrongly Agree

I have a plan for managing debt. *

Strongly DisagreeStrongly Agree

Workshop Expectations

Instructions: Please rate each statement below on a scale of 1 to 5, where:
1 = Strongly Disagree | 2 = Disagree | 3 = Neutral | 4 = Agree | 5 = Strongly Agree

I believe this workshop will help me improve my financial management skills. *

Strongly DisagreeStrongly Agree

I expect to gain a better understanding of budgeting and expense tracking. *

Strongly DisagreeStrongly Agree

I am interested in learning about available rental and utility assistance programs. *

Strongly DisagreeStrongly Agree

I feel this workshop will help me take steps toward financial stability. *

Strongly DisagreeStrongly Agree

Additional Questions

How would you rate your current financial situation? (1 = Very Poor, 5 = Excellent) *

Very PoorExcellent

How confident are you in managing your finances without assistance? (1 = Not Confident, 5 = Very Confident) *

Not ConfidentVery Confident