HTML Preview Dislocated Worker Monthly Budget Worksheet page number 1.
I:\JTC\SHARE\DISLOCATED WORKER\MONTHLY BUDGET WORKSHEET 2.DOC 4-10
DISLOCATED WORKER JOB SEEKER MONTHLY BUDGET WORKSHEET
Participant Name: _________________________Vocational Counselor: _______________________
MONTHLY HOUSEHOLD INCOME (include BOTH your income and spouse’s income)
Severance Pay Work/job(s) ________________
Unemployment GI Bill
Workers Compensation Child Support
County Food Support Social Security
County cash assistance Other
TOTAL MONTHLY HOUSEHOLD INCOME $ ______
MONTHLY HOUSEHOLD EXPENSES
Housing:
Rent or Mortgage _______________
Water/ Sewer _______________
Trash _______________
Electricity _______________
Heat (Gas) _______________
TV (Cable/Satellite) _______________
Telephone _______________
Home Insurance _______________
Property Tax _______________
Maintenance/Repairs _______________
Other _______________
Medical:
Insurance Premium _______________
Prescriptions _______________
Dr/Dental/Chiro _______________
Children’s Expenses:
Child Support _______________
Child care _______________
Activities/Sports _______________
Tuition _______________
_______________________________________
Signature
Transportation:
Car Payment
Insurance
Gasoline
Maintenance/Repairs
Personal:
Clothing
Hair Cuts
Entertainment
Gifts
Miscellaneous:
Food
Household supplies
Newspapers/magazine
Pet Care
Charge cards
Loan Payments
Other Monthly Expenses
TOTAL EXPENSES: $____________
INCOME – EXPENSES = $ ____________
______________________________________
Date