Coffee with an Elder Law Attorney "*" indicates required fields Step 1 of 2 50% Today's Date MM slash DD slash YYYY Birthday * Required MM slash DD slash YYYY Enter required information below. * Required First Last Email * Required Phone * RequiredResidence County * RequiredBentonWashingtonMadisonBaxterBooneCarrollIzardMarionNewtonSearcyStoneotherProfession * RequiredPublic/CommunityDieticianMedical StudentNursingNursing Home AdministrationParaprofessionalPatientPhysical TherapyPhysicianResidentSocial WorkStudentGender * RequiredMaleFemaleOtherRace * RequiredAfrican-AmericanAmerican IndianAsian/Pacific IslanderCaucasianHispanicMiddle EasternOtherAddress Street Address City State / Province / Region ZIP / Postal Code How did you learn of this event?My Center on Aging (the Schmieding Center)My Healthcare Provider (e.g., doctor, nurse, etc.)Web SearchFacebook PostEmail or TextWord of MouthThis field is hidden when viewing the formI consent, per above terms, to the use of my image by UAMS for program and event promotion * Required Yes No This field is hidden when viewing the formI want to receive email notice about other Schmieding Center events * Required Yes No Survey data is required by our funder to offer this program at no cost to participants. Only aggregate (group) data from this survey is reported.Which choice best describes my knowledge of the legal and financial plans I need to put into place for myself or my loved one. * Required Excellent Good Fair Poor SCSHE Which choice best describes my understanding of how to put elder law legal and financial plans into place. * Required Excellent Good Fair Poor SCSHE How would you rate your confidence in managing your legal affairs or those of a loved one? * Required Excellent Good Fair Poor SCSHE How would you rate your understanding of where to access resources to help plan for your future or that of your loved one? * Required Excellent Good Fair Poor SCSHE How would you rate your confidence in making a legal plan for getting older? * Required Excellent Good Fair Poor SCSHE