Please fill out your name and information.

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1
In approximately how many years do you plan to retire?
In 1 to 6 years
In 7 to 10 years
In 11 to 16 years
More than 16 years
2
Do you expect to withdraw one-third or more of your retirement savings within seven years?
(for retirement income, purchase of a new home, college tuition, etc.)

No
Yes, within 3 years
Yes, in 4 to 6 years
3
Have you set aside savings to cover expenses such as purchasing a home, college tuition, or financial emergency?

I have not set aside savings to cover such expenses
I have set aside savings to cover such expenses

Planning Consideration: Under unforeseen circumstances, such as a loss of income, many people need to draw on “long-term” money for short-term needs. If you don’t have an emergency fund, a conservative investment approach may be the most appropriate.

4
Approximately what portion of your total investable assets is in your retirement savings plan at work? (Investable assets include your emergency fund, plan assets, bank accounts, CDs, mutual funds, annuities, cash value of life insurance, stocks, bonds, investment real estate, etc. They do not include your principal residence or vacation home.)

Less than 25%
Between 25% and 50%
Between 51% and 75%
More than 75%

Planning Consideration: The lower the portion of total assets you’re investing, the more aggressive you might want to be in this portion of your portfolio.

5
Which ONE of the following describes your expected earnings over the next five years?
(Inflation has been about 2.5% on average over the past 30 years.)*

I expect my earning to increase and far outpace inflation (due to promotions, new job, etc.)
I expect my earnings increases to stay somewhat ahead of inflation
I expect my earnings to keep pace with inflation
I expect my earning to decrease (due to retirement, part-time work, economically depressed industry, etc.)

*Inflation is represented by the Consumer Price Index, which monitors the cost of living in the U.S.

Planning Consideration: If your income is likely to change, you may have more or less money to meet your expenses. For example, during a period when money is tight, you may have to dip into your long-term investments. A more conservative approach may enable you to depend on money being available

6
Choose the sentence below that best reflects your feelings about investment risk
I want as much assurance as possible that the value of my retirement savings will not go down.
I want to maintain a balanced savings mix with some fluctuation and growth.
I want my money to grow as much as possible, regardless of risk or fluctuation

Planning Consideration: Your comfort level with investment risk is important in determining how aggressively or conservatively you choose to invest.

7
a. Have you ever invested in individual bonds or a mutual fund or annuity that invests primarily in bonds? (aside from U.S. Savings Bonds)

No, and I would be uncomfortable with the risk if I did
No, but I would be comfortable with the risk if I did
Yes, but I was uncomfortable with the risk
Yes, and I felt comfortable with the risk

b. Have you ever invested in individual stocks or a mutual fund or annuity that invests primarily in stocks?
No, and I would be uncomfortable with the risk if I did
No, but I would be comfortable with the risk if I did
Yes, but I was uncomfortable with the risk
Yes, and I felt comfortable with the risk

Planning Consideration: The more experience you have with these two types of investments, the more comfortable you may be in leaving your money invested while riding out any market downturns.

8
How many dependents do you have? (include spouse, children you support, elderly parents, etc.)

None
One
Two or three
More than three

Planning Consideration: You may have responsibility for ongoing family obligations. This may suggest a more conservative approach.

9
Approximately what portion of your monthly take-home income goes toward paying off debt other than a home mortgage? (auto loans, credit cards, etc.)

Less than 10%
Between 10% and 25%
Between 26% and 50%
More than 50%

Planning Consideration: If a large portion of your income goes toward paying debt, you are more likely to need to have cash available to handle unforeseen circumstances.

10
Which ONE of the following statements describes your feeling toward choosing your retirement investment choices?

I would prefer investment options that have a low degree of risk associated with them (i.e., it is unlikely that my original investment will ever decline in value)
I prefer a mix of investment options that emphasizes those with a low degree of risk and includes a small portion of other choices that have a higher degree of risk but may yield greater returns
I prefer a balanced mix of investment options- some that have a low degree of risk and others that have a higher degree of risk but may yield greater returns
I prefer a mix of investment options- some would have a low degree of risk, but the emphasis would be on investment options that have a higher degree of risk but may yield greater returns
I would select only investment options that have a higher degree of risk but a greater potential for higher returns

 Planning Consideration: Your comfort level with investment risk is important in determining how aggressively or conservatively you choose to invest.

11
If you could increase your chances of improving your returns by taking more risk, would you…

Be willing to take a lot more risk with all of your money?
Be willing to take a lot more risk with some of your money?
Be willing to take a little more risk with all of your money?
Be willing to take a little more risk with some of your money?
Be unlikely to take much more risk?

 Planning Consideration: Your comfort level with investment risk is important in determining how aggressively or conservatively you choose to invest.

12
What portion of your retirement income do you expect to come from this retirement plan?

Less than 20%
Between 20% and 34%
Between 35% and 50%
More than 50%