Financial Coaching Request

Personal Information

First Name

Last Name

Cell Phone

Email Address

DOB

/ /

Occupation

#Children/Dependents

Which campus do you attend?

Marital Status

Single Married Widow Divorced Separated

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 Wills & Trusts

Are you experiencing a financial crisis?

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 Stewardship Class at Southeast Christian.

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 savings

Total retirement savings

Home Ownership

I rent my home I own my home

Monthly payment: (mortgage/rent)

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

Credit Card Debt

Monthly Credit Card Payments

Medical Debt

Monthly Medical Payments

Auto Loan Debt

Monthly Auto Loan Payments

Student Loan Debt

Monthly Student Loan Payments

Other Debt

Monthly Other Debt Payments

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

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

Leader Resources