Income and Expenses
After your application has been received and before you meet with your financial coach, use the following guide to make a list of your regular monthly expenses. During this session, you’ll create a working budget. It should take about 45 minutes. Please fill this out prior to your meeting with a CARes Financial Coach. NOTE: you must put a number in every box under Income and Expenses. If you have nothing to report, type 0. If spaces are left blank or you type letters, the form will not submit. Additionally, round up to the nearest dollar- do not use decimals or commas.
Name
*
First Name
Last Name
Date
*
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Month
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Day
Year
Date
Banking
Do you have a checking account? If so, what is the balance?
Do you have a savings account? If so, what is the balance?
Income
*Be prepared to provide proof of income*
What is your monthly income?
How many people in your household including you?
How many people in your household have income?
What is the amount of their income?
Do you receive child support? If so, how much?
Do you receive alimony? If so, how much?
Do you receive SSI or disability? If so how much?
Do you receive food stamps? If so, how much?
Do you have any other income? If so, how much?
Expenses
*Be prepared to provide proof of expenses (utility bills, phone bill, etc.)*
Housing
What is your rent/mortgage payment?
What are your cable, satellite, internet, and phone expenses?
How much do you spend on utilities(water/gas/electric)?
How much do you spend on food/at the grocery store?
How much per month do you spend on household supplies?
Debt
Do you have any personal, student, or payday loans?
Do you have any other loans payments? If so, what are those amounts?
Do you have credit cards? If so, what payments are you making?
Transportation
How much are you paying for auto insurance?
Do you currently have a car payment? If so, how much?
How much do you spend on gas per month?
How much do you spend on other transportation (bus/uber/lyft, etc.)?
Family
Do you pay for child support?
Do you pay for childcare? If so, how much per month?
What other family related expenses do you have?
How much do you spend on clothing per month?
What do you spend on laundry?
Medical
What are you paying per month for health insurance?
How much are you spending on medications for you and your family?
Recreation/Entertainment
How much do you spend on entertainment/recreation?
How much do you spend on eating out per month?
Miscellaneous
How much do you spend on personal car (hair/nails/beauty supplies)?
Do you make regular deposits into a saving account? If so, how much?
Do you pay for any gym memberships? If so, how much per month?
Do you contribute to your place of worship? If so, how much?
Do you pay for a storage facility? If so, what are the monthly payments?
Submit
Should be Empty: