Short getting to know you and a confidential view of your current financial situation

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

	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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Help me get to know you and prepare for our time together with this CONFIDENTIAL view of your current financial situation

About You

Financial Snapshot

Income

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

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.

Consumer Debt

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.