Special Needs Trust Estate Planning Questionnaire
Personal Information
Client Name
Address
Phone Number
Email
Beneficiary Information
Beneficiary Name
Date of Birth
Relationship to Client
Nature of Disability
Assets
Approximate Value of Estate
Asset Details (real estate, bank accounts, etc.)
Trust Structure
Proposed Trustee Name
Trustee Contact Information
Alternate Trustee(s)
Government Benefits
Is the beneficiary currently receiving government benefits?
Yes
No
Details of benefits (SSI, Medicaid, etc.)
Distribution Instructions
How should the trust assets be used/distributed?
Other Information
Additional Notes or Special Instructions