Complete this form to provide a breakdown of your net income (income minus expenses). Please note that not all expenses are recognized for
the purposes of determining financial aid eligibility.
Please list all sources of income you received during the 2017 calendar year.
$__________________ Income earned from work by Parent 1
(Name ______________________________)
$__________________ Income earned from work by Parent 2
(Name ______
________________________)
$__________________ Net business/farm income
$__________________ Rental income
$__________________ Interest/dividend income
$__________________ Withdrawals from pensions/annuities
$__________________ Severance pay
$__________________ Unemployment benefits
$__________________ Social Security Benefits
$__________________ Temporary Aid for Needy Families (TANF)
$__________________ Child support received
$__________________ Alimony
(List source __________________________)
$__________________ Veteran’s benefits (non-educational)
$__________________ Housing, food, and other living allowances
(i.e., military, clergy)
$__________________ SNAP benefits (aka Food Stamps)
$__________________ Disability benefits
$__________________ Cash support from others
(List source __________________________)
$__________________ All other income not previously reported
(Please specify ________________________)
$__________________TOTAL INCOME
Please list an average of your monthly expenses.
Fixed Expenses
$__________________ Rent/mortgage
$__________________ Electricity
$__________________ Gas
$__________________ Water/trash
$__________________ Telephone
$__________________ Internet/cable
$__________________ Automobile insurance
$__________________ Repayment of student loan(s)
$__________________ Payments for private school/college tuition
$__________________ Child care costs
$__________________ Child support payments
Flexible Expenses
$__________________ Food
$__________________ Gasoline
$__________________ Car maintenance/repairs
$__________________ Cloth ing
$__________________ Laundry/cleaning
$__________________ Personal care
$__________________ Medical, dental, vision, and p
rescriptions
$__________________ Recreation/entertainment
$__________________ Travel/vacation
$__________________ TOTAL MONTHLY EXPENSES
I certify that all information reported on this form and any attachments and subsequent information provided to the Occidental College
Financial Aid Office is true, complete, and accurate to the best of my knowledge. I understand that false statements or misrepresentations will
be cause for denial, reduction, withdrawal, and/or repayment of financial aid.
Parent Signature (no electronic signatures) Print Name
Date
If monthly expenses (multiplied by 12) exceed income, please explain how you meet your expenses:
If any source of income was due to a one-time event, please specify:
Other expenses, please specify:
STUDENT’S NAME:
OXY ID:
(NEW STUDENTS LEAVE BLANK)
INCOME/EXPENSE WORKSHEET - PARENT
2019-2020
Occidental College
Financial Aid Office
1600 Campus Road F-35
Los Angeles, CA 90041
Phone: 323-259-2548
Fax: 323-341-4961
finaid@oxy.edu
www.oxy.edu/financial-aid
