Help me get to know you and prepare for our time together with this CONFIDENTIAL view of your current financial situation
About You
Name
*
First Name
Last Name
Age
Type of Work
Missions, Business as Mission, NGO, Private Sector, etc.
Cell Phone
Email
*
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Spouse's Name
First Name
Last Name
Age
Type of Work
Phone
Email
example@example.com
Are you financially responsible for any dependents ?
Yes
No
Ages of dependents
That you are currently financially responsible for
Have you been through a personal finance course or program with the following?
Financial Peace
Crown
Compass
Other
How do you prefer to communicate?
*
Email
WhatsApp
SMS
Zoom
Other
Financial Snapshot
Income
What is your combined monthly net take-home pay?
How would you describe your income?
Regular, consistent paycheck
Irregular, varies from month to month
Do you use a monthly budget?
Yes
No
It will be helpful to have a copy of it for our conversation. This is a good time to review and update to your latest version.
Savings
Do you currently have any of the following?
Emergency Fund
Savings Account
Retirement Account
Non-Retirement Investment Account
Rental Property
Investment Real Estate
Pension
Other
It will be helpful for you to have a summary of the current value for these different accounts for our conversation. This is a good time to locate your latest account statements.
Do you own a home?
Yes
No
Do you rent a home?
Yes
No
Monthly Mortgage Payment
Monthly Rental Payment
Consumer Debt
Do you have any vehicle loans?
Yes
No
Total monthly auto payments
Current Debts
Rows
Total Owed
Auto Loans
Mortgages
Credit Cards
Student Loans
Tax
Medical
Other Debts
Are you behind in your payments on any debts or rent?
Yes
No
I know this is a stressful situation to be in. Please advise on which debts, by how much and by how many months. Are any in collections?
What Primary issue should we focus on during our exploratory session?
*
Budgeting
Debt Elimination
Collections
General Saving
Education Saving
Retirement Saving
Support Raising
Other
Please list your top concerns or questions about your selection(s) above. What keeps you up at night in regard to these issues or in general?
*
Thank you for taking the time to fill out this form. This information will be kept confidential and will only be seen by me. I look forward to assisting you take back control of your finances.
MacGegor Magruder macgregor@fieldlife.org +60166461985 +12252453030
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