Parent'S Monthly Cash Flow Statement Form

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Student Financial Services
Massachusetts Institute of Technology
77 Massachusetts Ave., Room 11-320
Cambridge, MA 02139  (617) 253-4971
sfs@mit.edu 
Parent’s Monthly Cash Flow Statement
We hope this form provides a chance for you to give a more complete picture of your family’s financial circumstances. To keep
the information you are providing consistent with your financial aid application, please fill out the following resource and
expense sections using monthly figures from the prior year (2015).
Student Name: ______________________________________________MIT ID #: _______________________________________
2015 Monthly Resources
Gross salary and wages
$_____________________________
Deductions from your salary/wages
Taxes Paid
$_________________
Retirement Contributions
$_________________
Other Contributions
$_________________
Equals: Net salary and wages
$_____________________________
Interest/Dividends
$_____________________________
Gross Rental Property Income
$_____________________________
Business Net Income
$_____________________________
Support from relatives/friends
$_____________________________
Other income
$_____________________________ (please explain) __________________________________
Total monthly resources
$_____________________________
2015 Monthly Expenses
Rent or mortgage
$_____________________________
Rental property expenses
$_____________________________
Automobile (loan, gas, insurance) $_____________________________
Utilities (heat, electricity, water)
$_____________________________
Phone/cable/internet
$_____________________________
Food
$_____________________________
Health insurance/medical expenses $_____________________________
Child care/tuition
$_____________________________
Other insurance (home, life, etc.)
$_____________________________
Personal (toiletries, cleaning, etc.) $_____________________________
Entertainment
$_____________________________
Credit card payments
$_____________________________
Other debt payments
$_____________________________ (please explain) _________________________________
Other
$_____________________________ (please explain) __________________________________
Total monthly expenses
$_____________________________
Total monthly resources minus total monthly expenses: ____________________________________________________________
(If monthly expenses exceed monthly resources, please attach an explanation as to how these costs are met)
Parent name(s): _____________________________________________________________________________________________
I attest that the information below is true and correct to the best of my knowledge. ____________________________________
(Parent signature)

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