Reimagine Wealth - Intake Form 2.0

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please complete this form before our first session. the purpose of this form is to help me understand where you’re at in regards to your relationship with wealth, money, and power, and what you most want out of working together. please be as honest as you can in these answers; all information will be held confidential.

we’ll review this form in our first call together and circle back on anything that hasn't been answered yet.

Email *

part 1: getting to know you better

these questions help me make the most of our time in the free discovery call, including whether we might be a good fit to work together, and where you might fall on my sliding scale pricing model.

your name and pronouns *

phone number *

please check off any of the following that apply to you: *

I identify as being wealthy and/or having access to class privilege

I am committed to my personal transformation

I am partnered / share my finances with someone else

I am trying to bring my partner(s), (chosen) family, friends, or community into this work

I have a trauma-informed professional or beloved that can support me outside of this work

I have dependents that I'm financially responsible for and/or whom I am a primary caregiver for

I have significant debt

I am unable to meet my own basic needs with my current access to wealth / money

none of these apply to me

Required

what goals are you currently working on or want to start prioritizing? *

what are your top challenges in shifting your relationship with money and/or accomplishing your goals? (where do you find yourself getting stuck?) *

imagine it's been one year since we started working together... what outcomes do you hope to achieve through us working together (what does success look like to you)? *

where do you most closely identify on Resource Generation's Class Distinction and Income Brackets? *

not sure - would love support figuring this out!

poor and working-poor

working class

middle class

managerial / upper-middle class

owning / ruling class

what is your best guess of the total amount of wealth / money you have direct access to? *

unsure - would love getting support to figure this out!

I am unable to meet my own needs with my current access to wealth / money

<$100k

100k - $500k

$500k - $1M

$1M - $2M

$3M - $5M

$5M+

Other:

what is your best guess of the total amount of wealth / money you expect to have access to in the future (through inheritance, trust distributions, the sale of a business or asset, RSUs, etc)? *

unsure - would love getting support to figure this out!

I do not expect to have access to wealth in the future

<$100k

$100k - $500k

$500k - $1M

$1M - $2M

$3M - $5M

$5M+

Other:

part 2: getting to know you better (optional questions)

these questions help me get to know you better and identify how we might be able to work best together.

we will work through these questions together during our first client session. if there are things you'd like to share in advance please do so, but if answering all of these feels overwhelming only answer / share what feels relevant and respects your energetic capacity.

what should I know about you and how to work well with you? what’s essential in building a good relationship with you? do you have any accessibility needs you would need met during our work together?

how would you describe your ability to stay organized with task lists and following through?

how are you with speaking up about your needs and advocating for what you need?

please check off any of the following that apply to you:

I am not on speaking terms with or am estranged from one or more parent(s)

I am on speaking terms with all parent(s) but find our relationship(s) fairly challenging

I get along with my parent(s) but I find our relationships to be emotionally unsatisfying

my parent(s) has (have) passed away

my relationship to my parent(s) is deeply shaped by the fact that I want or need access to their money

none of these options apply to me

Other:

what resources beyond financial capital do you have to support your well-being or move closer towards achieving your goals?

social capital - connections (influence, relationships)

experiential capital - action (embodied experience, internal wisdom)

material capital - materials, non-living physical objects (tools, buildings, infrastructure, mineral rights, fossil fuels)

living capital - carbon, clean water, clean air, nitrogen (soil, living organisms, land, ecosystems)

intellectual capital - ideas, knowledge (words, images, "intellectual property")

spiritual capital - prayer, intention, faith, karma (spiritual attainment)

cultural capital - songs, art, stories, rituals (community)

none of these options apply to me

Other:

what risks (financial or otherwise) are you willing to incur to achieve your goals? please check all that apply

willing to shift my lifestyle or experiment in lifestyle shifts in order to be more aligned to my values

willing to practice developing new habits and behaviors that are more aligned to who I want to be

willing to ask for help from others

willing to invest in options that provide a lower financial return than the benchmark

willing to invest in options that provide concessionary returns (3% return or lower)

willing to engage in conflict / difficult conversations with someone I care about and/or love

willing to be vulnerable and share about my experience with beloveds

willing to be vulnerable and share about my experience publicly

willing to explore other career / job options

willing to move to another location

willing to engage in conversation with someone I don't know well

willing to set and reinforce my boundaries in order to care for myself / show up for those I love

willing to risk my reputation or others' perception of me to be in alignment with my values / the call of social movements

N/A - I am not willing to take on any risks at this time

Other:

have you done any programs to unpack your own class experience / relationship to money, such as: Resource Generation (RG), Solidaire, Women's Donor Network (WDN), and/or money coaching programs?

Yes

Other:

Clear selection

what does the lifestyle you envision for yourself look like?

when it comes to your current lifestyle or the one you envision for yourself, what are your non-negotiables (these are things that are not up for compromise, debate, or change)?

Send me a copy of my responses.

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