Client Intake Information

YOUR CURRENT EMPLOYMENT INFORMATION:

YOUR CURRENT INCOME INFORMATION:

YOUR EMPLOYMENT HISTORY (recent to oldest):

EDUCATION

OTHER PARTY’S CURRENT EMPLOYMENT INFORMATION:

OTHER PARTY’S INCOME INFORMATION:

OTHER PARTY’S EMPLOYMENT HISTORY (recent to oldest):

EDUCATION

If you have a copy, please bring this to your appointment.

CHILDREN OF THIS RELATIONSHIP

Please list the full name, date and place of birth, sex, social security number, year/grade, school/college, and health of each child born to or adopted into this relationship.

List the addresses at which the minor children of THIS relationship have lived for the past five (5) years, and with whom they have lived. You need only go back five (5) years from the current month.

Names and ages of any other minor children not born to or adopted into this relationship, their other parent, and custody arrangements.