Parent Monthly Income And Expense Statement Template - Johns Hopkins University - 2017-2018 Page 2

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Section II: Sources of Income
Please list all sources of income that are used to meet the living expenses you listed in Section I. (Total monthly
income should equal or exceed total monthly living expenses. If not, please explain in Section III below.)
Average amount per
Average amount per
month in 2015:
month in 2016:
Parent wages/salary
$_
$_
Income from business
$_
$_
Child support
$_
$_
Housing support (military, clergy, etc.)
$_
$_
$_
$_
Social Security benefits
$_
$_
Supplemental Nutrition Assistance Program (SNAP)
$_
$_
Supplemental Security Income (SSI)
$_
$_
Support from family members
$_
$_
Temporary Assistance to Needy Families (TANF)
Unemployment benefits
$_
$_
Veterans benefits
$_
$_
$_
$_
Other:_____________________________________
Other:_____________________________________
$_
$_
$_
$_
Other:_____________________________________
Total monthly income: $__________________
$__________________
Section III: Additional Information
Please provide any additional information that would help us understand how you meet your living expenses. If more
space is needed, provide a separate page with the student’s name and ID number at the top.
Comments:
Parent Signature
Date
Please return completed form via postal mail, email, or fax using the contact information below.
fin_aid@jhu.edu
Office of Student Financial Services
3400 North Charles Street, Garland Hall 146
410-516-8028 phone
Baltimore, MD 21218-2683
410-516-6015
fax
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