HAVE YOU DEFINED YOUR STRATEGY FOR YOUR UPCOMING LIFE CHANGE? Complete the responses to the questions below. Let us know how well you have prepared for retirement and we'll show you what you might need to work on or what you might be forgetting. FREE Assessment! NO Obligation! TIP: Rank questions with responses "Less True" 1 - 5 "More True" the way the statement applies to you and your situation. Questions at the end with a blank fill-in box allow you to put in your own response to the question being asked. PLANNING FOR CHANGE... 1. I have thought about what I will do and where I will live when I retire. Less True - 1 2 3 4 5 - More True 2. I've have shared my plans, dreams and desires about retirement with my life partner. Less True - 1 2 3 4 5 - More True 3. I know exactly what my life partner's plans, dreams and desires for retirement are. Less True - 1 2 3 4 5 - More True INCOME... 4. I am working with a certified retirement planner. TrueFalse 5. I am investing in as many of the options available to me as possible in order to maximize my retirement savings. Less - 1 2 3 4 5 - More 6. I will have a monthly pension other than Social Security when I retire. YesNoUnsure 7. The degree that my monthly pension will impact my/our projected retirement income. Less - 1 2 3 4 5 - More 8. My life partner will have a monthly pension other than Social Security when he or she retires. YesNoUnsure 9. The degree that my life partner's monthly pension will impact our projected retirement income when he or she retires. Less - 1 2 3 4 5 - More 10. I am confident that Social Security will be available for me when I retire. YesNoUnsure 11. The degree that my Social Security will impact my/our projected retirement income. Less - 1 2 3 4 5 - More 12. The degree that I am confident that Social Security will be available for my life partner when he or she retires. YesNoUnsure 13. The degree that my life partner's Social Security will impact my/our projected retirement income. Less - 1 2 3 4 5 - More HEALTH... 14. The degree to which my health is a concern. Less True - 1 2 3 4 5 - More True 15. The number of times per week I exercise. Less True - 1 2 3 4 5 - More True 16. My weight is where it should be. Less True - 1 2 3 4 5 - More True 17. I watch my diet and monitor my fat intake. Less True - 1 2 3 4 5 - More True 18. The degree to which my life partner's health is a concern. Less True - 1 2 3 4 5 - More True 19. The number of times per week my life partner exercises. Less True - 1 2 3 4 5 - More True 20. My life partner's weight is where it should be. Less True - 1 2 3 4 5 - More True 21. My life parter watches his or her diet and monitors fat intake. Less True - 1 2 3 4 5 - More True 22. I am confident Medicare will be available to me when I retire. YesNoUnsure 23. I am confident that Medicare will allow me to have access to the doctors and services necessary for my health care. YesNoUnsure 24. I am confident that adequate prescription drug coverage will be available to me when I retire. YesNoUnsure 25. I/we plan to carry supplemental health insurance coverage. TrueFalseUnsure 26. I/we plan to carry long term healthcare insurance. TrueFalseUnsure HOME... 27. I would like to relocate to another city or to the country when I retire. Less True - 1 2 3 4 5 - More True 28. I would like a second home in another part of the country. Less True - 1 2 3 4 5 - More True 29. I would like to stay in my present home. Less True - 1 2 3 4 5 - More True 30. I would like to downsize to a smaller home. Less True - 1 2 3 4 5 - More True 31. I would like to move to an "Over 55" Community where some people may or may not be retired. Less True - 1 2 3 4 5 - More True 32. The degree to which being close to my family is important to me. Less True - 1 2 3 4 5 - More True 33. The degree to which being close to my friends is important to me. Less True - 1 2 3 4 5 - More True 34. The degree to which being close to my church is important to me. Less True - 1 2 3 4 5 - More True 35. The degree to which my social activities are important to me. Less True - 1 2 3 4 5 - More True 36. I want to live in a totally "retired" socially self-contained community. Less True - 1 2 3 4 5 - More True LEISURE... 37. The degree to which I enjoy sports such as golf, tennis, fishing, etc. Less True - 1 2 3 4 5 - More True 38. I have several hobbies that I have not been able to pursue and I am looking forward to spending time on them. Less True - 1 2 3 4 5 - More True 39. I want to travel and see the world when I retire. YesNoMaybe 40. I want to travel in an RV and see the United States and Canada. YesNoOccasionally 41. The degree to which I plan to become involved in ongoing activities with other retirees. Less True - 1 2 3 4 5 - More True 42. I don't really want to change my social activities much; I enjoy the comaraderie it has taken years to build. Less True - 1 2 3 4 5 - More True 43. I plan to go back to school. YesNoMaybe 44. I am content with a good book, some crafts and just relaxing. TrueFalse 45, In truth, I don't really have any real leisure interests. TrueFalse 46. I have a difficult time relaxing and spending my time doing non-work activities. TrueFalse SPIRITUALITY... 47. I am comfortable with where I am in my spiritual journey. Less True - 1 2 3 4 5 - More True 48. My spiritual life will have increased importance in my future. Less True - 1 2 3 4 5 - More True WORK... 49. I plan to work full time after I "officially" retire. YesNoMaybe 50. I plan to work part time after I "officially" retire. YesNoMaybe 51. I plan to open my own business after I "officially" retire. YesNoMaybe 52. The degree to which I feel I will need to work for additional income after I "officially" retire. Less True - 1 2 3 4 5 - More True 53. I plan to work on a volunteer basis after I "officially" retire to give back for all that I have received over the years. YesNoMaybe 54. The degree to which flexibility will be important to me. Less True - 1 2 3 4 5 - More True 55. The degree to which keeping my options open and available is important to me. Less True - 1 2 3 4 5 - More True FAMILY... 56. I have ___ children living at home and their ages. 57. I may have to care for one or more parents or in-laws when I retire. 58. The degree to which I am comfortable that I will be able to handle my responsibilities for other family members when I retire: OTHER NARRATIVE QUESTIONS... 59. I spend ___ hours each day/week (pick one) working at my job right now because: 60. I plan to retire when I am ___ years old because: 61. My career job is/was in the ____ field: 62. I was born in 19___: 63. I feel like I am ___ years old because: 64. I graduated from high school; have some college; have a Bachelor's Degree; have a Graduate Degree. (Please list your educational level and what your degree is, if any.) 65. I have the following concerns about retirement: Your Name: Your Email: Please take a moment to print your assessment before you submit it. Thank you. www.newretirementoptions.com Copyright© August 2004 by Diane D'Agostino and Diane D'Agostino Unlimited, Inc, all rights reserved. Text, graphics, and HTML code are protected by US and International Copyright Laws, and may not be copied, reprinted, published, translated, hosted, or otherwise distributed by any means without explicit permission.