Financial Empowerment Planning Questionnaire

Tell Us About You

The basics so I know who I’m talking to.

First Name (required)

Last Name (required)

Email (required)

Phone Number (required)

Best time to reach you optional

Year Born optional

Occupation optional

Are you currently retired?

Yes No Semi-retired

If not retired — how many years until you plan to retire? optional

Do you have a spouse or domestic partner?

Yes No

Do you have any dependents?

Yes No

Tell Us About Your Spouse or Partner

Skip this section if it doesn’t apply.

Spouse / Partner First Name optional

Spouse / Partner Last Name optional

Year Born optional

Occupation optional

Are they currently retired? optional

Yes No Semi-retired

Years until they plan to retire? optional

Tell Us About Your Dependents

Anyone you’re currently or potentially financially responsible for.

Do you have any children? optional

Yes No

Are any of them financially dependent on you? optional

Yes No

Please share names, ages, and how long they may be dependent on you optional

Do you have any other dependents (parents, siblings, other)? optional

Yes No

Do you expect to be providing financial support to someone in the future? optional

Yes No Maybe

Your Financial Situation

Where you are today — no right or wrong answers.

Where are you in the Dave Ramsey Baby Steps? optional

Do you currently have a written financial plan? optional

Yes No Working on one

What are your top financial priorities right now? optional

Do you own your home? optional

Yes No — renting No — other

Do you expect your housing situation to change in the next 5 years? optional

Yes No Maybe

Your Assets

Ballpark estimates are completely fine — all fields are optional.

Total value of retirement accounts (401k, 403b, IRA, Roth, etc.) optional

Total value of non-retirement accounts (brokerage, savings, CDs, etc.) optional

Total value of other assets (investment property, business equity, etc.) optional

Your Income & Expenses

Approximate figures are all we need — all fields are optional.

Annual household earned income optional

Other income sources (rental, side business, etc.) optional

Pension per year optional

Social Security per year optional

Do you have significant debt other than a mortgage? optional

Yes No

If yes — approximate total and type optional

Approximate annual household cost of living optional

Do you expect your income or expenses to change significantly in the next few years? optional

Your Goals & Vision

The most important section. Take your time — these answers will shape our entire conversation.

On a scale of 1–5, how confident do you feel about your personal finances right now? optional 1 = I worry about it constantly · 5 = Fully on track and secure

How would you describe your investment goal? optional

Grow my wealth as much as possible Grow within a comfortable level of risk Protect what I have while keeping up with inflation I’m not sure yet

How much of a loss could you tolerate in a single year? optional

I’d rather not lose anything A small decline (under 10%) would be manageable A moderate decline (10–20%) is okay if temporary A larger short-term loss is fine for better long-term growth

What have your investment experiences been like — positive or negative? optional

What is your vision for retirement? optional

If money, career, and obligations weren’t a factor — what would you most like your life to look like? optional

What are you hoping to find out through our meeting together? optional

What should I ask you that I haven’t asked yet? optional

Is there anything else you’d like me to know before we talk? optional

Pre-Meeting Questionnaire

Tell Us About You

Tell Us About Your Spouse or Partner

Tell Us About Your Dependents

Your Financial Situation

Your Assets

Your Income & Expenses

Your Goals & Vision