D: ESTIMATED INCOME/EXPENSES WORKSHEET
E: CERTIFICATION AND SIGNATURE
The following section requires you to provide your (and your spouse’s, if applicable) expected income for 2014. Please provide figures
for the entire year; do not report hourly or monthly wages or income. Include all income received from January 1, 2014 until now, and
estimate amounts to be received from now until December 31, 2014. This form may be completed in pencil.
Do not leave any line blank. List the yearly amount you expect to pay in expenses and receive from income in 2014. If no
income/expenses are expected, you MUST write “$0”.
EXPENSES FOR 2014
JAN. 2014—TODAY TODAY—DEC. 2014 TOTAL
Rent/mortgage $__________________ $__________________ $_______________
Utilities $__________________ $__________________ $_______________
Insurance: Home/apartment $__________________ $__________________ $_______________
Auto $__________________ $__________________ $_______________
No line
Tuition/fees $__________________ $__________________ $_______________
may be
Books/supplies $__________________ $__________________ $_______________ left blank!
Food $__________________ $__________________ $_______________ If $0, please
Clothing $__________________ $__________________ $_______________ provide an
Transportation (gas, repairs) $__________________ $__________________ $_______________ explanation
Car payments/lease $__________________ $__________________ $_______________
on a separate
Unreimbursed medical/dental $__________________ $__________________ $_______________ form.
Recreation $__________________ $__________________ $_______________
Other (specify): ____________ $__________________ $__________________ $_______________
____________ $__________________ $__________________ $_______________
TOTAL EXPENSES: $__________________ $__________________ $_______________
INCOME FOR 2014 JAN. 2014—TODAY TODAY—DEC. 2014 TOTAL
Student’s gross income from work $__________________ $__________________ $_______________
Spouse’s gross income from work $__________________ $__________________ $_______________
Interest/dividend income $__________________ $__________________ $_______________
Pensions/annuities $__________________ $__________________ $_______________
If your total
Unemployment compensation $__________________ $__________________ $_______________ expenses
Severance pay $__________________ $__________________ $_______________
exceed your
Alimony/spousal support $__________________ $__________________ $_______________ total income,
Social Security benefits $__________________ $__________________ $_______________ you must
Veterans benefits $__________________ $__________________ $_______________
provide a
Child support received $__________________ $__________________ $_______________
detailed
AFDC/TANF/SNAP $__________________ $__________________ $_______________
explanation
Resources from parents/relatives $__________________ $__________________ $_______________ of how you
Financial aid $__________________ $__________________ $_______________ plan to meet
Other (specify): ____________ $__________________ $__________________ $_______________ expenses.
TOTAL INCOME: $__________________ $__________________ $_______________
By signing this worksheet, I certify that all of the information reported is complete and correct. I also acknowledge that I have read and
agree to comply with all verification policies as stated by EWC. Failure to submit information in a timely fashion may result in the
application being filed as inactive with no further consideration and no federal aid for the academic year.
Student signature: ___________________________________________________ Date:___________________________
Printed name: ________________________________________________________________________________________
WARNING: If you purposely give false or misleading information on this worksheet, you may be fined, sentenced to jail, or both.
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