Name :   Email and Phone *: Date of Birth *: Long-term Care : Y N Life Insurance : Y N Insurance :  Amount, Term or Whole life? Debts: List all Mortgages List any Additional Debts Assets Home: Savings/Money Market Retirement Values: ORP TRS-Years of Service TDA IRA/SEP 401K Other Total Retirement Assets Priorities: (Please Rate) Savings Account : 1-Very Important 2-Important 3-Somewhat Important 4-Not As Important 5-Not Important Child's Education : 1-Very Important 2-Important 3-Somewhat Important 4-Not As Important 5-Not Important Retirement Income : 1-Very Important 2-Important 3-Somewhat Important 4-Not As Important 5-Not Important Minimize Estate Taxes & Costs : 1-Very Important 2-Important 3-Somewhat Important 4-Not As Important 5-Not Important Provide for Nursing Home/ Health Care : 1-Very Important 2-Important 3-Somewhat Important 4-Not As Important 5-Not Important Income for Dependents : 1-Very Important 2-Important 3-Somewhat Important 4-Not As Important 5-Not Important Additional Notes/Comments