Fillable Income and Expenses Student (Pitzer College)

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Income and Expenses Student (Pitzer College)

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The Income and Expenses Student (Pitzer College) form is 2 pages long and contains:

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  • 2 check-boxes
  • 49 other fields

Country of origin: US
File type: PDF

U.S.A. forms for Pitzer College

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Student Name (please print)
Student ID (if known)
Income and Expenses – Student
2020-2021
Please provide a breakdown of your income and expenses. Please note, not all expenses are recognized for the purposes
of determining financial aid eligibility.
2. Income and Expenses
Please list all sources of income you received during the 2018 calendar year (January 1, 2018 to December 31, 2018).
Please list an average of your monthly expenses. If something does not apply, please write $0 or N/A.
Yearly Income Monthly Expenses
$ Income earned from work by Student $ Rent/Mortgage
$ Income earned from work by Spouse $ Food/Groceries
$ Net business/farm income $ Utilities (Gas, Electricity, Water, Trash)
$ Rental income $ Internet/Cable
$ Interest/dividend income $ Telephone
$ Withdrawals from pensions/annuities $ Car Insurance/Car Payment
$ Severance payments $ Child Care
$ Unemployment benefits $ Medical Insurance
$ Social Security Benefits $ Out of Pocket Medical/Dental Expenses
$ Temporary Aid for Needy Families (TANF) $ Recreation/Entertainment
$ Child support received $ Gasoline/Public Transportation
$ Alimony, Source: $ Personal Care
$ Veteran’s benefits (non-educational) $ Clothing
$ Housing, food and other living allowances $ Other 1, Specify:
(i.e. military, clergy) $ Other 2, Specify:
$ SNAP benefits (aka Food Stamps) $ Other 3, Specify:
$ Disability benefits $ Other 4, Specify:
$ Other income not previously reported:
Specify:
Total Income:
$
Total Expenses:
$
1. Student Information
Whose information is reported on this form? (Check all that apply) Student Spouse
Student Name (please print)
Student ID (if known)
Income and Expenses – Student
2020-2021
3. Supplemental Questions
If any source of income was due to a one-time event, please clarify below.
If your expenses exceed your income, please clarify how expenses are paid and the source of funding (e.g., family
support, untaxed income, etc.).
4. Certification
I certify that the information reported on this form and all supporting documentation is true 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.
Student Signature Date
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Income and Expenses Student (Pitzer College)

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Completed 25 August 2020

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