Expense/resource Form
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2015-2016 Expense/Resource Form
STUDENT:____________________________________________________________________
FIDN#: A______________
Last name
First name
Clarification is needed to ensure you are being considered for the maximum amount of financial aid available. The 2014 income
reported on your financial aid application appears to be low. Please fill out the worksheet below, listing all of your income and
expenses. When completed, this worksheet should demonstrate how you supported yourself and/or your family in 2014. If you are
a dependent student, you must include parental information on the second page. In all cases, the Total 2014 Income (B) must
equal or exceed Total 2014 Expenses (A) recorded. Documentation may be requested to support the figures reported on this form.
STUDENTS 2014 ANNUAL EXPENSES AND INCOME
Expenses
Student & Spouse
Income
Student & Spouse
Rent
Earnings from all jobs (Tax &
$
Untaxed)
$
Mortgage
Unemployment compensation
$
$
Food
Withdrawals from savings
$
$
Car payment/Insurance
Social Security/Disability Benefits
$
$
Car maintenance/Gas
Welfare, AFDC, TANF, SNAP
$
$
Utilities/Telephone/Cable
Child Support Received
$
$
Credit Card Payments
Alimony/Palimony Received
$
$
Child Support/Alimony Paid
Expenses billed to you & paid by
List child(ren) and age below
$
others (total dollar value)
$
Clothing
Cash received from family and/or
$
friends
$
Entertainment
Financial Aid refunds received in
$
2014
$
Child Care
*Support provided by others
$
(Please explain below)
$
Unreimbursed Medical
Tribal Benefits received in 2014
$
(total dollar value)
$
Other: Explain below
Other: Explain below
$
$
Other: Explain below
Other: Explain below
$
$
(A) Total 2014 Expense
$
(B) Total 2014 Income
$
*Examples of support include food, shelter, clothing, non-cash gifts etc. Be sure to list the total dollar value of support received in 2014.
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
____________________________________________________________________________________________________________
Dependent students must complete the next page of this form.
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