Debt Consciousness Assessment - PRF Institute

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Debt Consciousness Assessment

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Debt Consciousness Assessment

Name *

First

Last

DISCLAIMER: Your information and data collected will be held in strict confidence. Your name will not be openly shared or connected with any of your responses, nor will we identify you with your responses to third parties without your consent. Please refer to https://prfinstitute.org/privacy-policy/ for further details.

Email *

Email

Confirm Email

Zip Code *

Are you an active member of a church or other religious organization?

Name of community, religious, non-profit, or business affiliation. *

Organizations are listed in order by city and state.

D1. Age Range *

18 to 24
25 to 34
35 to 44
45 to 54
55 to 64
65 to 74
74+

D2. Race/Ethnicity *

Black/African-American
White/Caucasian
Hispanic/Latino
Asian
Native American
Prefer not to answer
Other

D3. Marital status (as of today) *

Single (never married)
Married
Divorced
Divorced and Re-married
Widowed
Separated
Prefer not to answer

D4. Number of children (or dependents) *

This is to help us measure how many persons within a family unit that we could potentially assist. Enter N/A if you prefer not to answer.

D5. Employment status (primary) *

Employed
Unemployed
Retired
Self-employed
Military
Student
Other
Prefer not to answer

D6. Gender

Male
Female

#1: How would you describe your current level of debt? *

Don't know
A little burdened by it
Manageable
In way over my head

#2: Are you aware of your current debt-to-income ratio? *

Yes
No

#3: Are you aware of your balance-to-limit ratios for your credit accounts? *

Yes
No

#4: Have you been at least 30 – 120 days delinquent on any debts within the last 12 months? *

Yes
No

#5: Has any life situations (unemployment, laid off, medical, divorce, etc.) happened to you over the last 24 months that make it a challenge to pay your debts consistently? *

Yes
No

#6: Within the past 24 months, I have ______________ *

completely stopped paying a debt(s) that I owed.
made partial payment(s) on a debt(s).
paid all of my debts are required.

#7: Do you currently have any unpaid/negative debts due to co-signing for another? *

Yes
Possibly
No

#8: Have you recently (within the last 12 months) considering filing for bankruptcy? *

Yes
Yes - occasionally
No

#9: When was the last time you filed for a Chapter 7 or 13 bankruptcy? *

Never
1 – 2 yrs ago
3 – 4 yrs ago
5 – 7 yrs ago
+7 yrs ago

#10: Are you aware of people around you (family, close friends, church members, etc.) experiencing potential to significant debt crisis AND in need of positive intervention? *

Yes
No

#11: Do you have any unaddressed/negative debt situation(s) that you would like to address? *

Yes
No

#12: Which PRIMARY debt of yours would you work to eliminate if you had the chance? *

Student loan(s)
Mortgage
Credit Card(s)
Auto loan(s)
Title Pawn
Payday Loan
Child Support
Loan(s) to family/friends
Bankruptcy
Other loan(s)
N/A - I have no debt

Please select no more than three.

Phone

CONTACT US

3100 Gentian Blvd, Suite 100
Columbus, GA 31907

P.O. Box 2584, Phenix City, AL 36868

267.437.7999

admin@prfinstitute.org

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IF you desire a shift in your finances OR want to be a better steward OR want to address poverty head on OR need for strategic planning OR desire to help others become financially stable OR need someone to truly empower you with the tools needed to begin your financial transformation … then start with a FREE 15-minute consultation with
Dr. Nate Dunlap, Jr. or one of our seasoned Team members.

Click below for more details of all of our consulting services and monthly subscriptions.

FREE Consultation

IF you desire a shift in your finances OR want to be a better steward OR want to address poverty head on OR need for strategic planning OR desire to help others become financially stable OR need someone to truly empower you with the tools needed to begin your financial transformation … then start with a FREE 15-minute consultation with
Dr. Nate Dunlap, Jr. or one of our seasoned Team members.

Click below for more details of all of our consulting services and monthly subscriptions.

FREE Consultation

IF you desire a shift in your finances OR want to be a better steward OR want to address poverty head on OR need for strategic planning OR desire to help others become financially stable OR need someone to truly empower you with the tools needed to begin your financial transformation … then start with a FREE 15-minute consultation with
Dr. Nate Dunlap, Jr. or one of our seasoned Team members.

Click below for more details of all of our consulting services and monthly subscriptions.

FREE Consultation