Monthly Budget Form

Monthly Budget Form Student's Name Address Apt. State Phone City Zip Code E-mail Monthly Income Item Estimated monthly net income Other income Total Amount Provide Supporting Docs3 Comments Financial Aid Awarded For School Year Item Pell Grant Scholarship 1 Scholarship 2 Work/Study Program Other Total Amount Provide Supporting Docs4 Y Y Y Y Y Comments Semester Expenses Item Tuition Lab fees Other fees Books Deposits Total Amount Provide Supporting Docs5 Y Y Y Y Y Comments Monthly Budget Form Monthly Expenses Item Fixed Expenses Rent Utilities Water/Sewer/Trash Electricity Cable/Internet Cell phone Credit cards Visa AMEX Discover Other Insurance Renter's Auto Medical Dental Variable Expenses Groceries Auto expenses Gas Other Laundry Hair cuts Medical expenses Transportation Entertainment Miscellaneous Total $20/month limit Not allowed until guidelines established Limited to valley metro monthly bus pass rates. $50/month limit $50/month limit Y Not allowed until guidelines established $120/month/person limit Y Y Y Y Min state requirement only Not allowed until guidelines established Not allowed until guidelines established Y Y Y Y min. monthly payment. min. monthly payment. min. monthly payment. min. monthly payment. Y Y Y Y Basic package only. $60/month limit. Y Amount Provide Suporting Docs2 Comments Monthly Budget Form I certify that my answers are true and complete to the best of my knowledge. If this application leads to assistance, I understand that false or misleading information in my application may lead to termination of assistance. Signature: ______________________________________________Date: ___________ Selection Committee Review Comments Disposition: __ Approved __ Revision Required __ Disapproved Monthly Budget Form Expense Fixed Expenses Rent Utilities Water/Sewer/Trash Electricity Cable/Internet Basic cable w/ internet service or internet service only. Will only support a land line OR a cell phone. Not both. Cricket: Any individual plan NTE $60/month + tax. Others: Up to $60/month Minimum monthly payment only at time of initial budget review. Minimum monthly payment only at time of initial budget review. Minimum monthly payment only at time of initial budget review. Minimum monthly payment only at time of initial budget review. Basic coverage only. Minimum state required coverage only. Not allowed until guidelines established. Not allowed until guidelines established. Copy of rental agreement. Copy of recent bill from service provider. Copy of recent bill from service provider. Contract if it includes pricing or recent bill from service provider. Guidelines Supporting Documentation Cell phone Credit cards Visa AMEX Discover Other Insurance Renter's Auto Medical Dental Copy of recent bill from service provider. Copy of recent bill from service provider. Copy of recent bill from service provider. Copy of recent bill from service provider. Copy of recent bill from service provider. Copy of recent insurance statement. Copy of recent insurance statement. Copy of recent insurance statement. Copy of recent insurance statement. Variable Expenses Groceries Auto expenses Limit to $120/month/person. Monthly Budget Form Expense Guidelines Estimate miles to and from community college, work at current gas prices. Supporting Documentation Gas Show calculation. Other Not allowed until guidelines established. Only for use of public facilities if not available in residence. Limit to $20/month/person. $20/month limit. Laundry Hair cuts Medical expenses Transportation Not allowed until guidelines established. To be used for public transportation only if the student does not have a car. Limited to valley metro monthly bus pass rates. Entertainment Limited to $50/month. Miscellaneous Limited to $50/month.