Cash Flow Worksheet Monthly Income And Expense Form
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1
2Office of Student Financial Aid
P.O. Box 8795
Williamsburg, VA 23187-8795
757/221-2420, Fax 757/221-2515
CASH FLOW WORKSHEET
(PARENTS’ MONTHLY INCOME & EXPENSE BUDGET)
Student Name: ____________________________________ W&M ID Number: 93 ___________
(Last)
(First)
(M.I.)
This form should be completed by the student’s parents, not the student; the information we are requesting is for the parents’
monthly income and expenses, not the student’s. The parents should complete all sections below, sign and date the form,
then return it to our office.
SECTION I
Monthly Living Expenses
Next to each item, fill in the dollar amount of your average monthly living expenses for you and your spouse and/or
dependents (if applicable). If you share living expenses with others, indicate only that portion of expenses which is yours.
If an expense occurs other than monthly, please convert it to a monthly average and identify expense. Report only your living
expenses. Fill in all items. If an item does not apply, indicate this by writing “N/A”.
□
□
• Do you pay rent?
Yes
No
□
□
• Do you pay mortgage?
Yes
No
• If you pay neither rent nor mortgage, please explain:________________________________________________________________________________
Living Expenses That You Pay
Average Amount per Month
1. Home Mortgage/Rent
$
2. Food and Household Supplies
$
3. Clothing
$
4. Utilities:
Gas
$___________________________
Electric
$___________________________
Telephone
$___________________________
Cable
$___________________________
Other
$
5. Gasoline and Auto Maintenance
$
6. Public Transportation
$
7. Medical/Health Expenses (Identify:_____________________________________)
$
8. Auto Insurance (____________________________________________________)
$
9. Car Payment (Make:_____________________________Year:_______________)
$___________________________
(Make:_____________________________Year:_______________)
$___________________________
(Make:_____________________________Year:_______________)
$___________________________
(Make:_____________________________Year:_______________)
$
10. Credit Card Payments:
$___________________________
Type_____________________________________Balance______________________
$___________________________
Type_____________________________________Balance______________________
$___________________________
Type_____________________________________Balance______________________
$___________________________
11. Recreation (Identify:________________________________________________)
$
12. Miscellaneous______________________________________________________
$
13. Miscellaneous______________________________________________________
$
$
Total Monthly Living Expenses
(Continued on next page)
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