MoneyWise Questionnaire

Note: If you are a married couple, we ask that you both complete the questionnaire.
Personal Information
First Name: *
Last Name: *
Address 1: *
Address 2:  
City: *
Zip: *
Birth Date: *  (mm/dd/yyyy)
Home Phone: *  (000) 000-0000
Work Phone:    (000) 000-0000 x00000
Cell Phone:    (000) 000-0000
Email Address: *
Are you a member of one of the NPMI church campuses? *
Which campus of North Point
Ministries do you attend?		 *
Do you attend the
worship services?		 *
Have you, or are you currently serving in any ministry at one of the NPMI church campuses? *
If so, where?  
Are you in small group? *
If so, who is your small group leader?  
General Information
Have you ever been arrested
charged with or convicted
of a felony?		 *
If so, please explain:  
Are you currently employed? *
If so, where?  
If not, how long have you
been unemployed?		  
What is your job title?  
How much education have you had? *
Do you plan on continuing your
education?		 *
What is your marital status? *
If married, what is your spouse's name?  
How long have you been Separated,
Divorced, or Widowed?		  
How many children do you have? *
If married, is your spouse working?  
Have you been through financial
counseling before?		 *
Name of counselor or organization?  
What led you to seek out MoneyWise
at this time?		 *
Please list any ways your financial situation may be affecting you and others with whom you are in a relationship:*
Describe some specific things about yourself that concerns you and that you would change if you could:*
Family Background
Did your father handle money well?*
Did your mother handle money well?*
What was your father's view of debt and savings?*
What was your mother's view of debt and savings?*
What was the best thing your father taught you about money or finances?*
What was the best thing your mother taught you about money or finances?*
What was the worst thing your father taught you about money or finances?*
What was the worst thing your mother taught you about money or finances?*
How has the way your parent's handled money affected you and how you handle money?*
Are you still financially
dependent on your parents?		 *
Financial
Do you have a budget? *
Do you track it monthly?  
Is your current salary enough
to cover your budget and expenses?		  
Do you currently have debts that you are concerned about? *
What is your view on giving? *
What is your view on credit cards? *
Spiritual
Have you reached the place in your spiritual life where you know for certain that if you were to die today that you would go to Heaven?*
If you selected yes, according to your beliefs, on what basis would God allow you into Heaven?
When did this occur in your life?
Describe your personal relationship with Jesus Christ?
What is your religious background?*
If you are married, is your
spouse a Christian?		  
What would you like to see God do in your life?*
Summary
What would you like to see happen in MoneyWise?*
What specifically do you expect your MoneyWise mentor to do to help you with your concerns?*
Are you open to God's solution? *