Hey Friend!
The purpose of this form is to provide an overview of where you are at currently. It does not have to be perfect, you can fill it out to the best of your ability. Please take a few minutes to complete the Personal Financial Snapshot form below.
Personal Information
Your Name
{"type":"text","name":"__generic","width":100,"value":"","size":"Normal","validation":"NE","validationMessage":"Please fill in this item.","placeholder":""}
Age
{"type":"text","name":"age2","width":100,"value":"","size":"Normal","validation":"TN","validationMessage":"Please fill in this item.","placeholder":""}
Type of Work
{"type":"text","name":"__generic2","width":100,"value":"","size":"Normal","validation":"NE","validationMessage":"Please fill in this item.","placeholder":""}
Spouse Name (if applicable)
{"type":"text","name":"__generic3","width":100,"value":"","size":"Normal","validation":"NE","validationMessage":"Please fill in this item. If you are not married, type \"N/A\"","placeholder":"Enter Spouse Name or N/A"}
Spouse Age (if applicable)
{"type":"text","name":"age","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please fill in this item.","placeholder":""}
Spouse Type of Work (if applicable)
{"type":"text","name":"__generic4","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please fill in this item.","placeholder":""}
Number of Children or Other Dependents
{"type":"text","name":"children","width":100,"value":"","size":"Normal","validation":"TN","validationMessage":"Please fill in this item.","placeholder":""}
Income
What is your total household annual income (gross aka before taxes)?
{"type":"text","name":"income","width":100,"value":"","size":"Normal","validation":"NE","validationMessage":"Please fill in this item.","placeholder":"Include all income sources"}
Savings
How much do you have in savings (not including retirement)?
{"type":"text","name":"__generic","width":100,"value":"","size":"Normal","validation":"NE","validationMessage":"Please fill in this item.","placeholder":"Enter dollar amount here"}
When it comes to handling your money, you feel:
Please choose...AnxiousWorriedFrustratedConfusedConfident{"type":"select","name":"feelings","width":100,"value":"","size":"Normal","validation":"N1","validationMessage":"Please make a selection for this item.","options":"Please choose...\nAnxious\nWorried\nFrustrated\nConfused\nConfident"}
Housing
Do you rent or own?Please choose...RentOwn{"type":"select","name":"__generic19","width":100,"value":"","size":"Normal","validation":"N1","validationMessage":"Please make a selection for this item.","options":"Please choose...\nRent\nOwn"}
Consumer Debt
Do you have any vehicle loans / leases?
Please choose...YesNoI lease my vehicle{"type":"select","name":"__generic23","width":100,"value":"","size":"Normal","validation":"N1","validationMessage":"Please make a selection for this item.","options":"Please choose...\nYes\nNo\nI lease my vehicle"}
Do you have any credit card balances?
Please choose...Yes and a balance dueYes but $0 balance dueNoI don't own a credit card{"type":"select","name":"__generic27","width":100,"value":"","size":"Normal","validation":"N1","validationMessage":"Please make a selection for this item.","options":"Please choose...\nYes and a balance due\nYes but $0 balance due\nNo\nI don't own a credit card"}
Do you have any student loans?
Please choose...YesNo{"type":"select","name":"__generic31","width":100,"value":"","size":"Normal","validation":"N1","validationMessage":"Please make a selection for this item.","options":"Please choose...\nYes\nNo"}
What primary topic(s) are you interested in?
{"type":"checkbox","name":"__generic","width":100,"value":"","size":"Normal","validation":"C1","validationMessage":"Please check at least one item.","options":"Getting Started with Money\nSavings\nBudgeting\nDebt\nHome Buying & Selling\nRetirement\nCollege\nPayoff Mortgage Early\nReal Estate Investing\nInsurance\nTaxes\nMoney & Marriage\nSmart Money, Smart Kids\nMoney & Anxiety\nCareer\nBusiness & Leadership\nOther"}
If other...
{"type":"text","name":"__generic38","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please fill in this item.","placeholder":""}
List the top three concerns / questions related to your above selection(s):
{"type":"textarea","name":"__generic39","width":100,"value":"","size":"Normal","validation":"NE","validationMessage":"Please fill in this item.","height":80,"placeholder":""}
Please use the space below for anything else you would like to share prior to the group session:
{"type":"textarea","name":"__generic40","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please fill in this item.","height":80,"placeholder":"This is optional."}
Aaaand you're done! Bravo. Seriously, thank you so much for taking the time to complete this form and paint your "financial picture" for me. This will save us time at the beginning of the group coaching session and allow us to spend more time addressing your top priorities!
I'm excited to meet with you and see how I can help you address your money issues... until then!
Cheers,
Gary
