Parent Monthly Income And Expense Statement Template - Johns Hopkins University - 2017-2018
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2School of Arts & Sciences and Engineering, Office of Student Financial Services
Parent Monthly Income and Expense Statement 2017-2018
Student’s Printed Name
Student’s ID Number
Section I: Monthly Living Expenses
Parent: Next to each item, fill in the dollar amount of your average monthly living expenses. If you share living
expenses with others, indicate only that portion of expenses which you pay. If an expense occurs other than
monthly, please convert it to a monthly average. Report only your living expenses. Fill in all items. If an item does
not apply, indicate this by writing “N/A”.
Do you share living expenses with others?
YES
NO
o
If YES, with whom?
Do you pay rent?
YES
NO
Do you have a mortgage payment?
YES
NO
o
If you pay neither rent nor a mortgage payment, please explain:
Living Expenses that You Pay:
Average amount per
Average amount per
month in 2015:
month in 2016:
1. Housing – rent or mortgage
$_
$_
2. Food and household supplies
$_
$_
3. Utilities (gas, electric, phone, water, heating)
$_
$_
4. Gasoline and auto maintenance
$_
$_
5. Public transportation
$_
$_
6. Medical/health expenses NOT covered by insurance
$_
$_
7. Insurance (home, car, health, life, etc.)
$_
$_
8. Car payments (Make:______________; Year:_________)
$_
$_
(Make:______________; Year:_________)
$_
$_
9. Other: _______________________________________
$_
$_
10. Other: _______________________________________
$_
$_
11. Other: _______________________________________
$_
$_
Total monthly living expenses: $__________________
$__________________
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