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Family / Household Budget
(1) *Your Family LAST NAME:
Monthly Income
(2)
Monthly Salary/Wages:
(3)
Other Income:
Total:
Monthly HOUSING Expenses
(4)
Mortgage/Rent:
(5)
Phone/Cell Phone:
(6)
Utilities
(Electricity, Gas, Water)
:
(7)
Cable/Internet:
(8)
Other:
Total:
Monthly TRANSPORTATION Expenses
(9)
Car Payment:
(10)
Car Insurance:
(11)
Gas:
(12)
Maintenance:
(13)
Other:
Total:
Monthly CREDIT Expenses
(14)
Student Loan:
(15)
Personal Loan:
(16)
Credit Card(s) Combined
(17)
Other:
Total:
Monthly FOOD Expenses
(18)
Groceries :
(19)
Dining Out:
(20)
Other:
Total:
Monthly DEPENDENT SUPPORT Expenses
(21)
Medical
(22)
Clothing
(23)
School Tuition
(24)
Child Care
(25)
Other:
Total:
**FOR OFFICE USE ONLY**
MONTHLY NET INCOME
YEARLY NET INCOME
Monthly Income
Yearly Income
Monthly Expenses
Yearly Expenses:
Monthly Net Gain
(Loss)
:
Yearly Net Gain
(Loss)
:
HOPKINS HOUSE SCHOLARSHIPS & RECOGITIONS COMMITTEE
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