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

[Memo and Twelve-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 twelve months.

[Your letterhead]

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

FROM: [Agent Name & County Extension Center]

It's been a full year since you set your goals for increasing your savings and reducing your debt at the conclusion of our Money IN/Money OUT workshop sessions on [date of last session]. Even if you didn't reach the specific goals you set, I hope you feel good about the progress you've made.

Feel free to call me if you need more information about controlling credit or increasing savings at [............] . If you do need face-to-face credit counseling and don't know where the nearest office is located, call the National Foundation for Credit Counseling at: 800-388-2227 or check their web site at http://www.nfcc.org. This site also contains information about how to contact several national organizations affiliated with NFCC that provide telephone, mail or computer assisted credit counseling or debt 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 record, 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.

It will be very helpful to us in designing future programs to help people reduce debt and increase savings if you will respond to the Twelve-Month Survey on the back of this page-and return this unsigned sheet in the stamped, pre-addressed envelope.

Thanks for your cooperation-and good luck in reaching your financial goals!

TWELVE MONTHS FOLLOW-UP - [date/organization] - Money IN/Money OUT

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

The amount of money I've actually put into a savings account during the twelve months since setting that goal is: $__________

The difference between my savings account balance 12 months ago and TODAY is:

$_______MORE than 12 months ago

OR

$_______LESS than 12 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 12 months ago (athe mount I DID reduce it)

OR

$__________MORE than it was 12 months ago (amount my debt load increased)

What kind of spending plan forms and record keeping system are you using?

___forms from workshop
___loose in a box or desk drawer
___forms from other source
___labeled envelopes in box/drawer
___forms I developed
___accordion envelope file
___computer forms
___computer system
___other?___________________

How do you rate the value (to you) of Money IN/Money OUT on each item below?

1 = lowest value and 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 reporting 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(the overall finance charges) that I decide I need.

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

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

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 preparing a net worth statement annually to measure progress toward my goals.

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

To what extent do you feel that 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