Financial Coaching Request

Personal Information

First Name

Last Name

Cell Phone

Email Address

DOB

/ /

Occupation

#Children/Dependents

Southeast Campus

Marital Status

Single Married Widow

Spouse Information: (if applicable)

Spouse Name

Spouse DOB

/ /

Spouse Occupation

Street Address

Street Address 2

City

State

Zip

Current Situation

My financial concerns (check all that apply)

Budgeting Debt Reduction Negotiating with Creditors Other Real Estate Issues Retirement Planning I am experiencing a financial crisis

If other please Specify

My level of financial stress (scale of 1-10)

My willingness to adjust priorities & change behaviors: (scale of 1-10)

I have previously participated in a Financial Peace University class

Unique or special circumstances I want to make you aware of: (only complete if applicable)

Income, Assets & Debt

Total monthly household income (net take home pay; all sources)

Total value of all assets

Total savings

Total retirement savings

Home Ownership

I rent my home I own my home

Monthly payment: (mortgage/rent)

Remaining mortgage balance

Estimated home value

Consumer Debt: (vehicles, credit cards, non-mortgage loans)

Total non-mortgage debt

Total monthly payments

Coaching Request

What I’m hoping to accomplish with the help of a Financial Coach

I am currently getting help from another mentor or advisor

Other mentor or advisor

COMMITMENT: I am committed to actively participate with the Financial Coaching Ministry to apply Biblical principles to my life and finances. To the best of my ability I will faithfully keep appointments with my coach.

Are you willing and able to make this commitment?

YES NO

Submit

FINANCIAL COACHING REQUEST Entry

Personal Information

Spouse Information: (if applicable)

Current Situation

Income, Assets & Debt

Home Ownership

Consumer Debt: (vehicles, credit cards, non-mortgage loans)

Coaching Request

Locations

Watch

Who We Are

Find Your Place

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