Financial Snapshot – Financial Coaching

Appointment Date
Personal Information
Your Name*
First Last
Your Age*
Employment Type*
Are you Married?*
Spouse Name*
First Last
Spouse Age*
Spouse Employment Type*
Have you been through FPU?*
Number of Children or Other Dependents*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Phone*
Email*
Enter Email Confirm Email
Preferred Session Type*
Select One
- In Person
- Phone
- Video Conference

Income
What is your monthly net take-home pay?*
This is the total house-hold take home pay, after taxes are withheld. It should include all income sources (Employment, Alimony, Trust Funds, etc)
Do you have an irregular income?*
Does your income vary significantly from month to month? This is often a result of self employed, commission based, or other variable income that does not allow you to predict the majority of your monthly income.
Irregular Income Description*
Describe the nature of your irregular income. Is there a minimum amount that you would be comfortable "counting on" despite the fluctuations? (ie if your income is $2,000 - $3,000 per month, but rarely goes below $2,000, you could enter $2,000)
Do you use a monthly budget?*
Do you make a distinct, unique budget for every month?
Monthly Budgeting Tools*
Describe the tools and process you use for your monthly budget.
Savings
Do you have an emergency fund?*
An emergency fund is money set aside for emergencies only, and is neither "invested" nor mixed in with your other money.
How much is in the fund?*
Are you currently investing for retirement?*
Employer 401k, 403b, IRAs (traditional or ROTH), etc
What is your total retirement savings balance?*
What is your monthly contribution?*
Do you contribute to non-retirement savings?*
What is your total non-retirement savings?*
Not including your emergency fund.
What is your monthly contribution?*
Housing
Do you rent or own your place of residence?*
Are you current on your housing payment?*
What are the total monthly housing payments?*
Consumer Debt
Do you have any vehicle loans?*
What are your total monthly payments?*
Do you have any other debt?*
Credit Cards
Student Loans
Taxes
Other
List the amount and type

Step 1 of 3

Personal Information

Income

Savings

Housing

Consumer Debt