Money IN/Money OUT Survey Form for Six-Month Mailing

[Memo and Six Month Follow-Up Survey - to be printed on your letterhead. Also prepare a stamped envelope for each participant, addressed to you. Insert a copy of this survey and the SASE into a slightly larger envelope, but do not seal it. At the final session, participants will address the outer envelopes to themselves and insert a copy of their Confidential Memo (in addition to this survey and SASE). They will then seal the outer envelopes and give them to you - to be mailed back to them in six months.]

[Your letterhead]

TO: Money IN/Money OUT Participants at [Worksite or Employer or other group setting]

FROM: [Agent Name & County Extension Center]

Please take a few moments to let us know how much progress you've made toward the goals you set at the conclusion of our Money IN/Money OUT workshop sessions on [date of last session].

If you're having trouble getting expenses under control, and would like some additional information or ideas, please call me at (.........). If you need to meet with a personal credit counselor, you can find out the nearest location from the National Foundation for Credit Counseling at: 800-388-2227 or on the web at http://www.nfcc.org. This web site also contains information about how to contact several national organizations affiliated with NFCC that provide telephone, mail or computer assisted credit counseling or debit management services.

Above all, don't give up! Keep making PLANS for each month's spending and saving, and keeping RECORDS of how you actually use your money. Each time you compare your plan with your records, you will become more sensitive to the importance of each decision you make to buy something or put the money into savings instead - and will improve your ability to spend more carefully in order to reach the goals that are most important to you.

Please respond to the questions in this survey [front & back?]-and return this unsigned survey to me in the enclosed stamped, pre-addressed envelope.

SIX MONTH FOLLOW-UP SURVEY - [date/organization]- Money IN/Money OUT

My goal for putting money into a savings account each month was: $____________

The amount of money I have actually put into a savings account during the six months since setting that goal is: $____________

The difference between my savings account balance 6 months ago and TODAY is:

$____________ MORE than 6 months ago

OR

$____________ LESS than 6 months ago

My Goal for REDUCING my debt load over twelve months was $____________

The difference in my debt load TODAY is:

$_________LESS than it was six months ago (the amount I DID reduce it)

OR

$_________MORE than it was six months ago (amount my debt load increased)

Did you obtain a credit report from at least one Credit Reporting Agency?

Yes__________ No__________

If yes, were there any errors in your report?

Yes__________ No__________

If yes, did you request a correction?

Yes__________ No__________

If yes, have corrections been made?

Yes__________ No__________

Please rate the value to you of Money IN/Money Out on each item below

Circle the number that reflects your opinion. 1 = lowest value & 7 = highest value

The importance of understanding what money means to me - my money values

1....................2....................3.............. ......4. ...................5....................6...................7

The importance of keeping track of how I use my money

1....................2....................3.............. ......4. ...................5....................6...................7

How the credit system works

1....................2....................3.............. ......4. ...................5....................6....................7

How to reduce my use of credit

1....................2....................3.............. ......4. ...................5....................6....................7

How to reduce the cost of credit I use

1....................2....................3.............. ......4. ...................5....................6....................7

How to avoid or reduce spending in order to have money to put into savings.

1....................2....................3....................4. ...................5....................6....................7

The different purposes for saving money

1....................2....................3.............. ......4. ...................5....................6....................7

The usefulness of making a plan for my spending and saving

1....................2....................3.............. ......4. ...................5....................6....................7

The necessity for comparing my actual spending with my plan

1....................2....................3.............. ......4. ...................5....................6....................7

The value of annual net worth statements to measure progress toward goals

1....................2....................3.............. ......4. ...................5....................6....................7

To what extent do you feel you have improved your quality of life since taking MI/MO?

1....................2....................3.............. ......4. ...................5....................6....................7

_{North Carolina State University
College of Agriculture and Life Sciences
North Carolina Cooperative Extension Service
Family & Consumer Sciences Department}