THE LETTER OF INTENT

John F. Raycroft from the MetLife's Division of Estate Planning for Special Kids gave the FSEPAC community an informative workshop on the vital issues surrounding financial planning for families with dependents with special needs. One specific topic that resonated strongly with the audience was a Letter of Intent, which Jack describes as wish list or letter of love for your child. It is a fact-filled letter that you can leave behind for others so that they may best understand how you specifically want your child to be cared for when you are gone. Jack suggests that parents update it annually and keep it with their Wills and Trust. It is not legally binding, but can be used as a guide in caring for your special needs child. An outline of the Letter to fill in is below. For more information on Special Needs Financial Planning Jack Raycroft can be reached at 781-876-4125. THE LETTER OF INTENT FOR As part of the Estate Planning process for families with children with Special Needs, a Letter of Intent should be completed. Although this is not a legally binding document it will be very helpful to assure that your child’s future caregiver understands your wishes for your child. It will also quickly assist the caregiver in knowing all of your child’s needs. The information should be completed in as much detail as possible. Draw upon what you know about your child through observation and discussion with them. Document what you have learned and update the information regularly. The following pages are not meant to cover every detail that will encompass your letter. Each of your children has difference needs as we do for their future. This outline is meant as a general guide to follow. 23b55e7e-b07f-456c-820c-f9b118ca2a93.doc Page 2 of 10 CHILD’S DIAGNOSIS (list dates and sources) __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ MEDICAL INSURANCE POLICY INFORMATION (private and government programsspecify which type and policy numbers) __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ PHYSICIANS (list all physicians) Name: ___________________________ Address: __________________________ City, State/Zip: _____________________ Phone: ____________________________ Specialty: __________________________ Date of Last Visit: ___________________ Name: ______________________________ Address:_____________________________ City, State/Zip: _______________________ Phone: ______________________________ Specialty: ____________________________ Date of Last Visit: _____________________ 23b55e7e-b07f-456c-820c-f9b118ca2a93.doc THERAPISTS Name: ____________________________ Address:___________________________ City, State/Zip:______________________ Phone:_____________________________ Specialty: __________________________ Date of Last Visit:____________________ Name:____________________________ Address:__________________________ City, State/Zip:_____________________ Phone:____________________________ Specialty: _________________________ Date of Last Visit: __________________ NURSES (list name and additional medical equipment needed) Name: ____________________________ Address: __________________________ City, State/Zip: _____________________ Phone: ____________________________ Specialty: __________________________ Date of Last Visit: ___________________ Name: _____________________________ Address: ___________________________ City, State/Zip: ______________________ Phone: _____________________________ Specialty: ___________________________ Date of Last Visit: ____________________ Type and cost of medical equipment needed: ________________________________________ __________________________________________________________________ __________________________________________________________________ TESTING DONE: (types, reasons, where and when, including genetic) Type of testing done: _____________________________________________________________ Location of test center: ____________________________________________________________ Date of testing:__________________________________________________________________ Results of testing: ________________________________________________________________ Type of testing done: _____________________________________________________________ 23b55e7e-b07f-456c-820c-f9b118ca2a93.doc Location of test center: ____________________________________________________________ Date of testing: __________________________________________________________________ Results of testing: ________________________________________________________________ FOOD AND NUTRITION (likes, dislikes, and other factors) __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ GENERAL MEDICAL HISTORY (past and current immunizations, allergies, operations, hospitalizations, childhood diseases, seizures-include how to recognize one and what to do about it) __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ PARENTS’ FEELING ABOUT Dating: _______________________________ Sex: __________________________________ Religion: ______________________________ Birth Control: _______________________ Marriage: ___________________________ Future Care: ________________________ 23b55e7e-b07f-456c-820c-f9b118ca2a93.doc HOUSING (specify preferences and detailed information on past, present, and future plans) __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ IEP/IFSP (attach copies of current educational or family service plan) __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ DAILY LIVING SKILLS (describe current skill level and where assistance is needed) Money Management: ____________________________________________________________ Cooking: _____________________________________________________________________ Bathing: ______________________________________________________________________ Dressing: _____________________________________________________________________ Toileting: _____________________________________________________________________ Ability to travel independently: ____________________________________________________ SCHOOL/WORK (describe current situation and your thoughts for the future) __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ 23b55e7e-b07f-456c-820c-f9b118ca2a93.doc SOCIAL (List level of functioning, strengths, weaknesses, and preferences) __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ HOBBIES (list all interests including structured and unstructured recreation, exercise, vacation preferences, and absolute no-no’s) __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ FUNERAL/BURIAL ARRANGEMENTS (list your preferences) __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ 23b55e7e-b07f-456c-820c-f9b118ca2a93.doc LIST CHILD’S FRIENDS/AIDES/HELPERS __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ FINANCIAL ARRANGEMENTS (disposition of insurance, property, investments, income) __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ OTHER FACTORS AND CONSIDERATIONS __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ 23b55e7e-b07f-456c-820c-f9b118ca2a93.doc IMPORTANT NAMES AND ADDRESSES Guardian: _________________________ Address: ___________________________ City, State/Zip:______________________ Phone: ____________________________ Trustee/Trust: Address: ___________________________ City, State/Zip: ______________________ Phone: _____________________________ Financial Advisor/Conservator Address: ____________________________ City, State/Zip: _______________________ Vocational Contact: ___________________ Address: _____________________________ City, State/Zip:________________________ Phone: ______________________________ Caseworker: __________________________ Address: _______________________________ City, State/Zip:___________________________ Phone: _________________________________ Phone: ___________________________ Gov’ Benefit: _____________________ Address: _________________________ City, State/Zip:____________________ Phone: __________________________ School/Work Contact: ____________ Address: ________________________ City, State/Zip: ___________________ Phone: __________________________ Executor/Will: _______________________ Address: _____________________________ City, State/Zip:________________________ Phone: ______________________________ Advocate: Address:__________________________ City, State/Zip: ____________________ Phone: ___________________________ 23b55e7e-b07f-456c-820c-f9b118ca2a93.doc ADDITIONAL CHILD RELATED IINFORMATION Name: ______________________________ Date of Birth: ________________________ Blood Type: _________________________ Social Security No: ____________________ Clothing Shoe Size: ____________________ Ancestry: ____________________________ Languages Spoken: ____________________ City, State/Zip: _______________________ Mother’s Name: ______________________ Father’s Name: _______________________ Father’s SS#: _________________________ Father’s Date of Birth: __________________ Favorite Things (pets, toys, people, and hobbies): ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ Complete Birth History and Developmental Milestones: ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ Nickname: __________________________ Place of Birth: _______________________ Gender: ____________________________ Height: ______ Weight: ______ Citizenship: _________________________ Religion: ___________________________ Address: ___________________________ Phone: _____________________________ Mother’s Maiden Name: _______________ Mother’s SS#: _______________________ Mother’s Date of Birth: ________________ Phone # if living elsewhere: _____________ 23b55e7e-b07f-456c-820c-f9b118ca2a93.doc NOTES __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ 23b55e7e-b07f-456c-820c-f9b118ca2a93.doc