Monthly Expense & Income Worksheet

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Type of Monthly Expense Cost Per Month Rent / Mortgage Amount contributed by you your parents Amount contributed by other people / agencies (include source) Source: Utilities Services (gas, water, cable, electric, cell home phone, trash removal, etc.) Insurance (medical / dental / vision, etc.) Doctor visits, medications, and other reoccurring medical expenses Food expenses Child care expenses, if applicable Source: Source: Source: Source: Source: Transportation / Automobile (car payments, car insurance, gasoline, public transportation passes, etc.) Source: Additional Explanation of Monthly Income and Expenses Include any additional explanation of your family s monthly income and expenses below, if needed..

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