Assessment Mentorship Form

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Money Zen Savings and Debt Repayment Mentorship Fit Form

Please answer the following questions to help us understand your financial situation and goals. This information will help determine if the mentorship program is the right fit for you.

1. What is your current monthly income (before taxes)?

a. Under $50,000

b. $50,000 - $75,000

c. $75,000 - $100,000

d. Over $100,000

2. What types of debt are you currently managing? (Check all that apply):

a. Credit card debt

b. Student loans

c. Mortgage

d. Personal loans

e. Medical bills

f. Other (Please specify)

3. Approximately how much total debt do you have?

a. Under $10,000

b. $10,000 - $25,000

c. $25,000 - $50,000

d. Over $50,000

4. How urgent is your need to pay off this debt?

a. Very urgent – it’s affecting my day-to-day life

b. Somewhat urgent – I want to reduce it soon

c. Not urgent – but I want a solid plan in place

5. What challenges have you faced in paying off your debt so far? (Select all that apply):

a. Lack of a clear plan

b. Impulse spending

c. High-interest rates

d. Unexpected expenses

e. Irregular income

f. Other (Please explain)

6. What financial goals do you want to achieve alongside paying off debt? (Select all that apply):

a. Build an emergency fund

b. Save for retirement

c. Invest in stocks or real estate

d. Save for a home or major purchase

e. Fund a child’s education

f. Other (Please specify)

7. What are you hoping to gain from this mentorship program? (Select all that apply):

a. Personalized guidance on debt repayment

b. Accountability and regular check-ins

c. A detailed plan to manage debt, save, and invest

d. Support in changing financial habits

10. Why do you feel you are ready for this type of mentorship?

Full Name *

Phone *

Email *

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